Adaptive communication methods and systems for facilitating the gathering, distribution and delivery of information related to medical care

ABSTRACT

Automated methods and systems are disclosed for persistently facilitating the timely gathering, monitoring, distribution and delivery of information related to medical care where such may include: (1) finding a communications channel for effectively attempting a message delivery to a specific target person at a specified time; (2) deliverable message content to limitations of a chosen communications channel; adaptively finding a targeted recipient even if the latter is highly mobile and/or has travel patterns or communications-channel preferences that change over time; (3) verifying that a targeted recipient has actually received an attempted delivery within an applicable time limit; (4) automatically recognizing that an urgent message delivery-attempt was not timely completed and adaptively alerting responsible entities of the in completion; and (5) automatically recognizing that an urgent change or non change of condition has occurred by virtue of information gathered during an automated or manually-conducted Interview where physician expected positive progress prior to Interview and adaptively alerting responsible entities of the changed or unchanged condition based on the urgency of the change or non-change.

1. FIELD OF DISCLOSURE

The present disclosure of invention relates to problems encountered inservice providing organizations such as may be found in the medicalfield wherein service-supporting communications are expected to becompleted between persons responsible for providing services and/orpersons who receive services. More particularly, the disclosure addressthe medical-services providing field wherein health or medicalcare-related information is gathered from, and/or exchanged between,and/or sent for delivery to individuals engaged in medicalservice-related communications. The individuals or entities involved insuch communications may comprise one or more of: (a) Patients, (b)Medical Service Providers (e.g. doctors, nurses, etc.), Medical TestingFacilities' Personnel (e.g., lab technicians), and/or automatedservice-providing agents.

2A. CROSS REFERENCE TO PATENTS

The disclosures of the following U.S. patents are incorporated herein byreference:

(A) U.S. Pat. No. 5,926,526; entitled METHOD AND APPARATUS FOR AUTOMATEDPATIENT INFORMATION RETRIEVAL, and filed Dec. 29, 1995 by Seymour A.Rapaport, M. D., Jeffrey A. Rapaport, et al, as U.S. application Ser.No. 08/581,749; and

(B) U.S. Pat. No. 6,192,112 B1, entitled MEDICAL INFORMATION SYSTEMINCLUDING A MEDICAL INFORMATION SERVER HAVING AN INTERACTIVEVOICE-RESPONSE INTERFACE, and filed Aug. 5, 1997 as U.S. applicationSer. No. 08/906,726 by Seymour A. Rapaport, M.D., Jeffrey A. Rapaport,et al.

2B. CROSS REFERENCE TO RELATED OTHER PUBLICATIONS

The following publications are cited here for purposes of reference:

(A) National Cholesterol Education Program (Journal of the AmericanMedical Association (JAMA), May 16, 2001, pp. 2486-2497.

3. RESERVATION OF EXTRA-PATENT RIGHTS AND RESOLUTION OF CONFLICTS

After this disclosure is lawfully published, the owner of the presentpatent application has no objection to the reproduction by others oftextual and graphic materials contained herein provided suchreproduction is for the limited purpose of understanding the presentdisclosure of invention and of thereby promoting the useful arts andsciences. The owner does not however disclaim any other rights that maybe lawfully associated with the disclosed materials, including but notlimited to, copyrights in any computer program listings or art works orother works provided herein, and to trademark or trade dress rights thatmay be associated with coined terms or art works provided herein and toother otherwise-protectable subject matter included herein or otherwisederivable herefrom.

If any disclosures are incorporated herein by reference and suchincorporated disclosures conflict in part or whole with the presentdisclosure, then to the extent of conflict, and/or broader disclosure,and/or broader definition of terms, the present disclosure controls. Ifsuch incorporated disclosures conflict in part or whole with oneanother, then to the extent of conflict, the later-dated disclosurecontrols.

4. BACKGROUND

An average patient may not appreciate the extent to which themedical-services providing industry is a communications-intensiveenterprise fraught with the potential for missed and miscommunications.Consider as a small scale example, a solo practitioners office. (Amedical services-providing organization may have merely one doctor init, or merely one other kind of medical services-providing person in it,although typically medical SPO's are comprised of more than one person;e.g., a nurse, a receptionist, etc.) Test results may be streaming intothe one physician's office at all hours for different patients and fromdifferent laboratories or specialists and coming in by way of telephonecalls, facsimile machines, email, regular hardcopy mail and/or othercommunication channels and modalities (e.g., peer-to-peer computercommunications). Some of the test results may be important ones thatneed urgent responding to while most are probably routine ones thatmerely report results within expected normal ranges. To the untrainedeye, it may be hard to differentiate one type of report from the other.As the various reports are coming in through the various communicationchannels, the affected doctor may be busy running about his or heroffice ping ponging between the servicing of one patient in one waitingroom to another in another room, and/or to talking with other medicalservice providers (e.g., nurses, radiologists, other doctors, etc.) inthe interim all while perhaps being unaware that an important report mayhave come in and is in need of urgent responding to. Aside from beinghighly mobile within his/her own office suite, the doctor may at timesbe situated in his/her car and may be engaged in driving to the hospitalfor an emergency consultation when a possibly-critical lab result comesin If the lab result is not truly critical, it would be inappropriate todistract the doctor from his/her driving activities and/or mentalconcentration on other issues by ringing the doctor's cell phone orpager at that time. One of the many communications problems which facethe medical services industry can therefore be characterized as how toefficiently differentiate emergency reports from normal ones and how tolocate and inform the appropriate physician of a situation at anappropriate time without overwhelming the doctor with volumes of routinedata and distracting the doctor from more pressing matters.

Another of the communications problems facing the medical servicesindustry (even in a small-scale, solo practice) is that patients may becalling in at all hours with questions about their ongoing medicaltreatment, with concerns about their medical conditions, or with theintent of scheduling a new appointment, or with the desire tore-schedule a missed appointment. A worse problem is that some patientsmay not be trying to contact the doctor's office at all because theybelieve it is entirely the doctor's responsibility to contact them ifsomething is wrong. Some of the commonly believed myths among laypatients is that, “(A) If I do not hear from the doctor's office thatmeans everything is OK. (B) Even though I am feeling much worse, thedoctor has already seen me, diagnosed the situation, and I should not becalling in again to disturb the doctor and complain like a big baby.”

Unfortunately the first myth (“If I do not hear from the doctor's office. . . ”) is an illogical conclusion that can be amiss for many a reason.The patient who is not hearing from his/her doctor may not realize thatthe reason is because, as some examples: (1) the battery on their (thepatient's) personal cell-phone has run out of energy, or (2) that theirhome telephone receiver is off the hook or (3) that their answeringmachine has run into a problem and is not recording or letting messagesget through, or (4) that their home facsimile machine (if they have one)is out of paper. It is possible as yet another reason why the patienthas not heard from the doctor's office, that (5) a nurse at the doctor'soffice may have temporarily misplaced the patient's file when she wassupposed to call the patient about an abnormal test result and that iswhy the patient is not being contacted. It is yet further possible that(6) the test results did not even arrive from the laboratory becausethere is a communications break down between the lab and the doctor'soffice (e.g., the lab report was lost) or (7) the wrong test wasperformed and its results came back normal, or (8) the patient'sspecimen was lost and a test was not even done.

The illogic of the second, above-cited myth (“Even though I'm feelingworse, . . . I should not disturb the doctor . . . ”) should also beapparent. If the doctor is not aware of the deteriorating patientcondition, how can the doctor knowingly respond to it. Perhaps thepatient is experiencing a severe allergic reaction to just-prescribedmedicine and needs to be taken to a hospital emergency room immediately?It is not beneficial to either the patient's or the doctor's intereststo use a communications system which discourages patients fromcontacting the doctor's office with their concerns and which does notassure that legitimate ones of such concerns are actually brought to thedoctor's attention—as opposed to just sitting on a loose piece of paperby the receptionist's desk. So many things can go wrong, that it is awonder the medical-re delivery system works at all. Luckily, in terms ofstatistics, when a particular communications failure occurs, the onemissed or mis-communication usually does not have serious consequences.However, once every so-many thousands of cases, such a failure leads tounnecessary catastrophe and exposure of the physician and/or otherMedical Service Providers (MSP's) to legal malpractice suits.

The above-given description of a communications-based hazards in a solopractitioner's practice is just a small scale example. Imagine how muchmore complicated the picture gets when one deals with a multi-physicianpractice group or a hospital. The chances for missed communications andmiscommunications grows astronomically. The laws of probability indicatethat such unfortunate events will therefore happen more often. It iswell understood that it is important to have timely and effectivecommunications between two or more of a given patient andservice-related persons who are involved directly or indirectly in theproviding of medically-related services to that given patient. Propercommunication between a Medical Service Provider (e.g., doctor) and aPatient, and/or between other service-related persons, may be essentialto the delivery of quality medical care. However, conventional practicesdo not account for many of the things that can go wrong.

Conventionally, in the medical field, attempts to gather, record,convey, and deliver important information may include a variety ofdifferent kinds of interviews and different channels for moving thegathered information from the point of collection or creation to theperson or persons who most likely (or most urgently) need to receivethat information. There may be, for example, a telephonic interviewbetween patient and nurse in which the patient has questions or concernsto relay to the nurse-practitioner about progress following an initialoffice visit. If some significant development is uncovered by the nurse,and the doctor needs to be informed quickly, then hopefully the oraland/or paper-based results will catch up with the doctor in a hallwaybefore the doctor disappears into a next waiting room and beginsexamination of a next patient. The telephonically-gathered results mayalert the physician to certain unusual items in thus-far-gatheredinformation and/or to unusual patterns, and these may assist or guidethe physician in his/her provision of timely patient care. However, inthe time-pressured rush of a modern medical practice, thetelephonically-originated paper work and/or orally-acquired informationmay get diverted or delayed and not get to the doctor on time. Or, giventhat doctors are only human, some items may escape the doctor'sattention. There is also the possibility that the patient and/orinterviewer left out some important information because a particularquestion was not understood by the patient or nurse. Such missedopportunities, oversights and/or like problems which may be associatedwith information gathering, distribution and delivery may lead toinefficient and degraded provision of medical care. Conventional methodsand equipment used in the medical field for information gathering and/orinformation distribution often fail to provide remedies for problemssuch the ones introduced in the above examples.

A closer study of the situation reveals that there are manyopportunities for missed communications and miscommunications due tocomplications on the patient's side of the equation, and due tocomplications on the Medical Service Provider's (MSP's) side of theequation. Patients can be highly mobile and hard to locate. Each patientmay have available to him or her, at respective locations and times ofday, a different assortment of communication tools by way of which thepatient may be effectively reached or not, including wired telephone,wireless telephone, telephone answering machine, facsimile machine,wireless portable computer, desktop computer, and so forth. The contextof the patient when a delivery attempt is made is also a factor. Forexample, a patient may be temporarily or permanently hearing-impaired,visually-impaired, distracted, disoriented, or otherwise disposed when acommunication delivery-attempt is made by way of a delivery channel thatis inappropriate for the patient's current context. Multiply thepossible locations at which a given patient may be found withtime-of-day, with patient context, and with probable communication toolat hand, and you already have a complicated set of possiblepermutations. Add to that the possibility that some patients do notanswer telephone calls directly but rather screen calls with ananswering machine and then call back only if they feel like it and youcan see how the risk for failed communications can grow. In the casewhere an automated answering machine is a link in theattempted-communications chain, you have a situation where the doctor'soffice may not know if the initial call was recorded at all by theanswering machine, or was recorded on the correct or a wrongly-dialedanswering machine (some machines do not self-identify), or was listenedto by the intended recipient (e.g., the patient), or by another personwho inadvertently erased the message from the doctor's office and didnot pass the message along. You also have an example of a situationwhere the doctor's office should not be distributing confidentialinformation via that communication channel because it is not clear whowill be picking up the dispensed message.

Problems on the Medical Service Provider's side of the equation tend tobe equally if not more complicated. A given physician may be highlymobile and hard to locate at certain times. Each doctor may have, atrespective locations and times of day, a different assortment ofcommunication tools by way of which they may be reached or not. Like,patients, doctors and/or other medical service providers may haveindividual contexts whereby they may be temporarily or permanentlyimpaired or involved in particular tasks that inhibit them fromeffectively receiving or comprehending a given communication when itcomes in. Also, the numbers and types of entities that a doctor's officeneeds to communicate with, and their respective availabilities andcontexts, often define a vastly larger set of possibilities than dothose parts of the medical-care delivery system that the typical patientcommunicates with. By way of some examples, the doctor's office may behave different pharmacies calling in to request prescription refills, orto ask questions about a specific patient or to convey and gather otherinformation. Hospitals or external specialists may be calling in withresults, inquiries, care suggestions, etc. Visiting nurses may becalling in to report on patient needs. Information may be arriving atthe Medical Service Provider's central office at different times of day,by way of different communication channels (e.g., phone, fax, etc.), indifferent formats (which formats can include hardcopy formats as well asdifferent computer communication formats). This chaotically incomingdeluge of data is typically not pre-sorted according to urgency. Looseslips of paper with important information on them may get misplacedbecause the person handling it (e.g., a clerk without medical training)may not appreciate the information's significance (e.g., an abnormalpotassium level) and the need for swift action. Without automatedassistance, the conventional approach to medical-services relatedcommunications is a prescription for eventual disaster.

Examples of communications between Medical Service Providers and/or aPatient that tend to be important include: 1) reporting normal andabnormal test results; 2) arranging further tests, office visits, andmedical procedures as may be appropriate, as well as following-up onthese arrangements to make sure the arranged actions are actuallycarried out; 3) following up on the progress of patients with acuteillnesses, 4) providing periodic health maintenance and monitoringservices (which may include sending vaccination reminders, medicalinstructions, as well as periodic gathering and evaluation of patienthealth information); and 5) following up on Patients who have missedscheduled appointments.

For the Patients' welfare it may be valuable to immediately informcertain Medical Service Providers of: (a) significantly abnormal testresults, (b) situations where Patients are not doing well after aprescribed course of therapy, (c) situations where Patients' healthstatus is showing signs of deterioration, and (d) situations wherePatients did not follow through on essential referrals, tests, orappointments.

There are situations where patients may want to be immediately informedof developments in their treatments or where patients may want toimmediately inform their care-givers of a concern or development. Forexample, some patients may want to immediately know about their own testresults when those results become available, and about theinterpretation of such results given the context of the patient's ownhealth status (e.g. for example, what the patient's cholesterol levelshould normally be within the patient's particular context includingthat of age, sex, and past heart or other illness). After starting aparticular treatment, a patient may desire to have a means for easilycommunicating concerns regarding their progress to the involved MedicalService Providers, so that, if a follow up is appropriate, such a followup on the concern will occur. Further, a given Patient's course ofhealth care might be improved by early notification being sent to theappropriate Medical Service Provider of detection of significantdeviations from the patient's prior state of health.

The volume of communications involved in trying to attain one or more ofthe above goals may easily exceed the capacity of conventional medicalpractices and systems. Medical personnel, facilities and systems areoften stressed by trying to maintain conventional levels ofcommunication which generally do not include one or more of thebeneficial add-ons mentioned above. Patient's health care may suffer dueto the inability of conventional medical systems to consistently andeffectively perform one or more of the beneficial medical communicationactivities outlined above. It is commonly-accepted knowledge in themedical services community that poor communications may often play asignificant role in many medical malpractice allegations.

SUMMARY

The present disclosure covers automated and adaptive systems and methodsfor facilitating medical-service related communications such as thoseinvolved in the exemplary problem situations described above.

In accordance with a first aspect of the present disclosure, anMSP-alerting interface is provided for selectively, effectively andefficiently: communicating to an MSP (Medical Service Provider)information that the Medical Service Provider is likely to consider asbeing vital to the quality of medical services being rendered to aspecific one or more patients.

In accordance with a second aspect of the present disclosure, anadaptive communications system is provided for adaptively facilitatingthe effective delivery of medical service information to Patients and/orMedical Service Providers in real-time, non-real-time, automated and/orpartly-automated fashions based on probable location, probable-availablecommunication tools and/or probable contexts of the targetedrecipient(s). In one embodiment, Medical Service Providers can use suchan adaptive communications system to communicate essentially all testresults to their Patients on or before a predefined time deadline. ThusPatients can be instructed to contact the Medical Provider if they arenot timely informed of all theirtest results. The carrying out of thisinstruction can act as a feedback check on the results-deliveringperformance of the adaptive communications system and as a feedbackcheck on the quality of medical or health care services being providedto the respective patients. Automated follow up on the carrying out ofthis instruction can also provide future predictors (e.g., attributes)about the data retrieval habits of the targeted patient.

In accordance with a third aspect of the present disclosure, an adaptivecommunications system is provided for adaptively delivering reschedulingnotifications to patients who missed their scheduled appointments,notifying those patients to reschedule the missed appointment. Automatedfollow upon the carrying out of such rescheduling suggestions can alsoprovide adaptive feedback (e.g., revised patient attributes) on whatdelivery-attempt strategies are likely to be most successful for a givenpatient during different times of day and/or by way of differentcommunication channels and/or under other patient-centric contexts.

In accordance with another aspect of the present disclosure, an adaptivecommunications follow-up system is provided for automatically alerting aresponsible Medical Service Provider of a failure by a targeted entityto retrieve or send an important communication within a prespecifiedtime window and/or of a failure by an entity to otherwise actappropriately in relation to one or more delivery-attempts involvingsuch a high-priority communication.

Other aspects of the disclosure will become apparent from the belowdetailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

The below detailed description section makes reference to theaccompanying drawings, in which:

FIG. 1A is a communications flow diagram showing a medical careenvironment in which progress monitoring and/or managing computers inaccordance with the present disclosure are deployed;

FIG. 1B is a block diagram of a server computer that may be configuredin accordance with the present disclosure to provide automated andadaptive communication of medical services related information;

FIG. 2 is a block diagram of a client computer that may be configured inaccordance with the present disclosure to provide automated and adaptivecommunication of medical services related information;

FIG. 3A illustrates a first portion of an object data architecture thatmay be used in an adaptive communications system that is structured inaccordance with the present disclosure;

FIG. 3B overlaps with FIG. 3A and illustrates a second portion of theobject data architecture;

FIG. 4 is a block diagram of software components that may be used inaccordance with the present disclosure for Interview formation anddelivery;

FIG. 5 is a detailed block diagram of software components that may beused in accordance with the present disclosure for Interview formationand delivery;

FIG. 6 illustrates different relationships that may exist between Personobjects and Interview objects executing in an Application Program thatis structured in accordance with the present disclosure;

FIG. 7 illustrates different relationships that may exist between aPerson object and several Interview objects and several Applicationsthat are structured in accordance with the present disclosure;

FIG. 8A illustrates a login screen that may be used by a Medical ServiceProvider in accordance with the present disclosure;

FIG. 8B illustrates another login screen that may be used by a MedicalService Provider to log-in into a foreign account in accordance with thepresent disclosure;

FIG. 9A illustrates yet another login screen that may be used by aMedical Assistant to log-in into one or more authorized accounts inaccordance with the present disclosure;

FIG. 9B illustrates an account selection screen that may be used by aMedical Assistant to choose which accounts he or she will use during alogin session;

FIG. 10A illustrates an alerted action-items summarizing mechanism(e.g., an Alert Summary Screen) that may be used by a Medical ServiceProvider to learn of, and/or take responsive action on, action-itemsthat are alerted by the System as calling for relatively quick attentionthereto;

FIG. 10B is a block diagram of an Alerts generating and handling signalflow within a System provided in accordance with the present disclosure;

FIG. 11 illustrates a Person-Finding screen which may be used by aMedical Service Provider, Medical Assistant or another authorized personto locate and/or access information in the System about Patients orother persons and/or to define Patient Groups;

FIG. 12 illustrates an Interview formulation screen which may be used bya Medical Service Provider to formulate a Test-Results Reporting Dialogthat is to delivered to a Patient in accordance with the presentdisclosure;

FIG. 13 illustrates another Interview formulation screen which may beused by a Medical Service Provider to formulate an Acute IllnessMonitoring Interview that is to delivered to a Patient in accordancewith the present disclosure;

FIG. 14 illustrates another Interview formulation screen which may beused by a Medical Service Provider to formulate a Test Follow-UpInterview whose Dialogs are to be delivered per a schedule to a Patientin accordance with the present disclosure;

FIG. 15 illustrates another Interview formulation screen which may beused by a Medical Service Provider to formulate a Custom Interview thatis to delivered to a Patient in accordance with the present disclosure;

FIG. 16 illustrates another Interview formulation screen which may beused by a Medical Service Provider to formulate a Health MaintenanceInterview that is to delivered to a Patient in accordance with thepresent disclosure;

FIG. 17 illustrates an Interview Reviewing screen which may be used by aMedical Service Provider used to review the status of a Test-ResultDelivering Interview whose in-completion triggered a Retrieval Alert inaccordance with the present disclosure;

FIG. 18 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of an OfficeVisit Follow Up for Sore Throat Interview whose in-completion triggereda Retrieval Alert in accordance with the present disclosure;

FIG. 19 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of a CustomMessage Interview whose in-completion triggered a Retrieval Alert inaccordance with the present disclosure;

FIG. 20 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of a RequiredTest Interview whose in-completion triggered a Retrieval Alert inaccordance with the present disclosure;

FIG. 21 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of a HealthMaintenance Interview whose collected information triggered anInformation Alert in accordance with the present disclosure;

FIG. 22 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of an OfficeVisit for Asthma Follow-Up Interview whose collected informationtriggered an Information Alert in accordance with the presentdisclosure;

FIG. 23 illustrates another Interview Reviewing screen which may be usedby a Medical Service Provider used to review the status of a Test-ResultDelivering Interview whose in-completion triggered a Retrieval Alert inaccordance with the present disclosure;

FIG. 24 illustrates a Delegated Alert Follow-Up screen which may be usedby a Medical Assistant to handle a delegated follow up on a Test ResultDelivery Interview whose in-completion triggered a Retrieval Alert inaccordance with the present disclosure;

FIG. 25 illustrates an Interviews finding screen which may be used by aMedical Service Provider to locate for review and/or editing, sentInterviews whose delivery has been initiated within a System inaccordance with the present disclosure;

FIG. 26 illustrates an Account Settings reviews screen which may be usedby a Medical Service Provider to review and/or change settings in his orher Account within a System in accordance with the present disclosure;

FIG. 27 illustrates an Interviews Opening screen which may be used by aPatient or another authorized Target to view, review and/or respond toInterviews he or she has received in accordance with the presentdisclosure;

FIG. 28A illustrates a first Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/or respondto an Interview for an Office Visit Follow Up for a Sore Throat which isbeing delivered in accordance with the present disclosure;

FIG. 28B illustrates a second Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/or respondto an Interview concerning Lipid Test Results which is being deliveredin accordance with the present disclosure;

FIG. 28C illustrates a third Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/oracknowledge an Interview concerning Lipid Test Results that has beendelivered in accordance with the present disclosure;

FIG. 28D illustrates another Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/oracknowledge an Interview concerning Health Maintenance issues (e.g.,vaccinations scheduling) that has been delivered in accordance with thepresent disclosure;

FIG. 29 illustrates a further Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/oracknowledge an Interview concerning results of a chemical screeningbattery test that has been delivered in accordance with the presentdisclosure;

FIG. 30 illustrates another Opened Interview screen which may be used bya Patient or another authorized Target to view, review and/oracknowledge an Interview concerning results of a lipid panel test thathas been formulated and delivered in accordance with the presentdisclosure;

FIG. 31 illustrates a further, Opened Interview screen which may be usedby a Patient or another authorized Target to view, review and/or respondto a Health Maintenance Follow Up Interview concerning apreviously-detected congestive heart failure, where the HealthMaintenance Follow Up Interview is being conducted in accordance withthe present disclosure;

FIG. 32 illustrates a Patient's Account Settings screen which may beused by a Patient or another authorized Target to view, review and/ormodify the Patient's Account settings within a System in accordance withthe present disclosure;

FIG. 33 illustrates an Administrator's Locate/Add screen which may beused by a System Administrator to locate and/or add and/or deletePatient Records to a System in accordance with the present disclosure;

FIG. 34 illustrates an Administrator's Patient-Record Editing screenwhich may be used by a System Administrator to view and/or edit PatientInformation and/or Patient Channel Information within a System inaccordance with the present disclosure;

FIG. 35 illustrates an Administrator's Account Settings screen which maybe used by a System Administrator to review and/or change his or herAccount Settings within a System in accordance with the presentdisclosure;

FIG. 36 illustrates a displayed Chart Note for a given Patient whoserecords are kept within a System in accordance with the presentdisclosure;

FIG. 37 illustrates a Patient Information screen which may be used by aMedical Service Provider to review Patient Information kept within aSystem in accordance with the present disclosure;

FIG. 38 illustrates a Communication Channels Preference screen which maybe used by a Medical system Provider to review and/or edit a Patient'sCommunication Channels information as kept within a System in accordancewith the present disclosure;

FIG. 39A illustrates an Interview Data Structure which may be generatedand/or transmitted as a signal within a System in accordance with thepresent disclosure;

FIG. 39B illustrates details of a Dialog Data Structure which may bedeveloped and/or transmitted as a signal within a System in accordancewith the present disclosure;

FIG. 40A is a block diagram illustrating how Dialog Data Structures maybe re/formulated, instantiated, sent to targets via a scheduler andtheir delivery results may be returned; and

FIG. 40B is a block diagram illustrating how an Application Server mayprovide an I/O firewall and scalability.

BRIEF DESCRIPTION OF PSEUDO-CODE APPENDICES

The below detailed description section includes pseudo-code appendicesin which:

Exhibit 1 is a pseudo code listing example of a Dialog Data Structurefor a follow up office visit for asthma in accordance with the presentdisclosure;

Exhibit 2 is a pseudo code listing example of a Dialog Data Structurefor reporting a chemistry battery of tests to a Patient in accordancewith the present disclosure; and

Exhibit 3 is a pseudo code listing example of a Dialog Data Structurefor delivering a result of a Streptococcus test to a Patient inaccordance with the present disclosure.

Overview of an Adaptive Communications System

An overview is first provided of an adaptive communications system(“System”) that is structured in accordance with the present disclosureso as to introduce its possible (I) communication capabilities; (II)user interfaces; and (III) instantiation processes.

I. Communication Capabilities

A System in accordance with the present disclosure may be designed foruse in a wide variety of settings, including from that a single MedicalProvider facility (e.g., solo practitioner office) to that of amulti-specialty organization; and to that of a general service hospital.Such a System should be able to offer its various communicationsservices either within a restricted, on-premises environment, or over anopen channel network such as the World Wide Web where the operations ofthe System may be coordinated by one or more application serviceproviders.

In one embodiment, the System conducts communicative transactionsdescribed herein as “Interviews” by using a variety of communicationchannels and modalities. The communication channels and/or modalitiesmay include those that rely on one or more of sound-detection (e.g.,touch tone), speech-recognition (including speaker identification and/orspeech-to-text conversion), conversion of text to speech, compilation ofcomputer files containing data formatted according to Hypertext MarkupLanguage (HTML), Extensible Markup Language (XML), Voice Over InternetProtocol (VOIP), instant messaging, Wireless Application Protocol (WAP),Wireless Hypertext Markup Language (WHTML), and plain or Rich text aswell as channels and/or modalities that may operate according to otherelectronic and/or optical communication protocols. The so-formattedcommunications may be sent and delivered over a wide variety of devices,including telephones, mobile wireless phones, pagers, computers(including desktop, laptop, palmtop and other mobile forms of automatedand programmably instructable machines), as well as other forms ofelectronic and/or optical data-conveying devices. Many of the markupprotocols such as the above-mentioned HTML and XML protocols, may callfor the use of browsers (computer programs) that are executed within acorresponding computer, wireless phone, palm-held computer or otherinformation-conveying device for generating user-understandableinformation. Such devices may be used to exchange user-understandableand/or user-centric information, including information produced by thehere-described adaptive communications system, over a network, which mayinclude wireless portions.

Various types of physical layer and primitive layer technologies may beused to achieve information communication between these devices and suchbase-level technologies may include various networking protocols (suchas TCP-IP and Instant Messaging, and User Datagram Protocol (UDP)), datamarkup languages (such as XML and SOAP), as well as other technologiessuch as network-content browsers, digital or analog voice-bandcommunicators, text-to-speech converters, and speech-recognitionsubsystems. It should be noted proprietary protocols may be used as wellas industry standard ones.

An adaptive communications system in accordance with the presentdisclosure may be structured to provide user-centric and/or customizedcommunication delivery. By this we mean that the System should be ableto automatically determine how and/or when to deliver specific kinds ofinformation (e.g., an MSP-alerting report), and in so-doing the Systemshould take into consideration one or more of the following factors: (1)the urgency of Interview content (for example, by automaticallydetermining whether there is alerted information in the Interview), (2)the context of the Interview, such as determining what type of people(e.g., medically-trained or not) are to participate-in (who are beingreferenced to by) the Interview and what their respective, user-centriccontexts probably are (e.g., is it appropriate to disturb them now withthis type of message delivery-attempt?), (3) the status of the Interview(e.g., the number of prior delivery attempts that appear to havefailed), and (4) information gathered from a successful one or moredeliveries of the Interview (e.g., responses of the communicationrecipient or recipients).

The System may be configured to deliver several Interviews to a givenPerson (or automated agent) in a single, successful contact attempt.These several Interviews may or may not come from different sources(such as different Medical Providers). In an alternate embodiment, eachInterview from a correspondingly different Application (e.g., associatedwith a different hospital or other medical-facility) may be restrictedto being delivered to a given Person in a respective single, actualcontact.

The System may be configured to attempt to deliver, in response to asingle command, separate instances of a single given message to eachindividual in a predefined group of Persons (or automated agents) usingone or an ordered group of Delivery Strategies.

The system may be configured to coordinate information delivery attemptswith the predefined delivery goals such as: (a) encouraging precedencefor higher priority information, (b) appropriately utilizingcommunication channels that are most likely to succeed at a giventime-of-day for a given recipient through the use of sequenced DeliveryStrategies that are target-centric, and (c) using designated DeliveryChannels and times-of-delivery attempt(s) that take into considerationdelivery resource availability as currently seen by the System,permissions of users to acquire different levels of confidentialinformation via available channels and customizable delivery preferencesof users. Delivery strategies can be made responsive to past deliveryhistory.

The System may ensure security through the use of login proceduresspecific to Roles and privilege limitation specific to a Person'sRole(s) in each Application. Logs may be kept of all actions on theSystem that record the Role, Person Identity, time stamp, and actiontaken. Messages sent over the Internet or a like untrusted channelshould be encrypted. In an embodiment, web pages accessed by users arekept behind the page-holding facility's firewall.

In one embodiment customized phrases are used to allow classification ofalerted Patient Interviews for quality assurance purposes.

Recipient Groups may be defined as (1) a collection of Person ID's or(2) by Persons who have particular Attributes values that fall within agiven range and/or that equal one or more specific values. The Systemcan then deliver one instantiated Interview to each member that belongsto a specified recipient Group.

The System may utilize a Role-based security architecture. Each Personobject may be assigned relations to other objects (such as anApplication, an Interview, a Topic, another Person, an Interview Dialog,or the System) by the assignment of a Role Type. The Role Type providesa context in which the Person object interacts with the other object.This Role Type context may be used to determine permissions the givenPerson object has with the other object.

The System may use Role Types to define permissions and dictate systembehavior. Relationships between certain objects may require a specifickind of Role. The Role defines how the objects are related. When arelationship is formed, certain Attributes may be required for a givenobject to form that relationship. These Attribute values may have to beentered in the proper object as a precondition for the relationship tobe created and to be valid. In one embodiment, if an Attribute valuethat is required does not exist, the System will add a default Attributevalue for the Entity that is missing a required Attribute.

In one embodiment, Places (meaning the physical or logical location of agiven Person or other object) also have Role relationships and RoleAttribute requirements.

The System should keep detailed, time stamped logs regarding Systemactivity, including Interview delivery and delivery attempts, content,and information gathering.

Alerts may be automatically set either by the System using predefinedrules, or they may be set by manual invocation by a knowledgeableMedical Service Provider (e.g., an R.N. or a physician). Alerts may beused to selectively notify various Medical Providers or Testing FacilityPersonnel of problems encountered in making urgent delivery attemptsand/or of recently-gathered and important Patient information. In onenon-preferred embodiment, one or more pre-selected, or all patients maybe given the ability to manually invoke an Alert that notifies anappropriate Medical Service Provider that the patient wants to becontacted immediately. Such an Alert may then appear on the MSP's AlertScreen or on another alert-summarizing and reporting mechanism. If thepatient is using a computer-network based channel (e.g., the Internet),then each delivered Interview may include a “Reply-Please Message”button or the like which can be activated by the patient to issue anAlert to the doctor's office for an immediate call back. If atelephone-like, voice channel is instead being used, one of thevoice-based dialogs may walk the patient through a process that causesthe System to issue an Alert to the doctor's office for an immediatecall back. In most instances it is not desirable to allow patients todirectly Alert their physicians because such an option could overwhelmthe doctor with nonessential communications. Instead it is better formanually-invoked Alerts (if any) that are generated by patients to firstgo through a Medical Assistant for knowledgeable filtering (screening)and possible handling before being sent onto the physician as an actualAlert.

II. Automated Medical Provider to Patient Communications

As indicated above, if information is not selectively filtered, MedicalService Providers may be undesirably drowned in a deluge of routineinformation and may fail to pick out the one urgent, proverbial needlein the haystack. A adaptive communications system in accordance with thepresent disclosure preferably reports urgent and already-filteredinformation by using an Alert Summary Screen or other,channel-appropriate reporting schemes (e.g., voice-only reports) thatpresent important data regarding a given Patient to the responsibleMedical Service Provider in a concise manner that is immediately usefulto that Medical Service Provider. Such filtered information can includeone or more of the following items:

-   -   (1) Test results that require substantially immediate Medical        Provider review;    -   (2) Notification Signal(s) identifying Patient(s) who have been        treated and are not progressing as would be normally expected;    -   (3) Notification Signal(s) identifying Patient(s) who have not        yet followed through in timely manner on important recommended        tests and/or appointments;    -   (4) Notification Signal(s) identifying Patient(s) who are not        following prescribed health maintenance protocols;    -   (5) Notification Signal(s) identifying Patient(s) whose        currently-gathered data-records indicate significant changes in        their health status;    -   (6) Notification Signal(s) identifying Patient(s) who have        failed to appear at a scheduled appointment and have not yet        rescheduled the missed appointment; and/or    -   (7) Notification Signal(s) identifying Patient(s) who have not        yet retrieved important test result information, for example,        information that would have alerted those patients to quickly        contact an appropriate Medical Service Provider for follow up.

In accordance with the present disclosure, a result-reporting means maybe included in the System for automatically reporting to a subjectpatient, and preferably in a manner that is consistent with reportingstandards of the reporting, medical facility, the normal results ofsubstantially any test that has been ordered for that patient within themedical practice and received by the medical practice. Normal resultscan therefore be automatically forwarded to Patients independently ofthe taking of further action by their Medical Service Providers (therebybypassing a processing of a below-described, Alert Summary Screen oralternate, alert-summarizing and reporting mechanism).

If the Retrieval Deadline date/time of a given Patient, as defined by acorresponding Database rule or a System standard or by the MSP, isexceeded and it is automatically determined by the System that the givenpatient has not yet retrieved a correspondingly given communication, theMedical Provider who is related to the still-incomplete Interview may beautomatically notified of this situation by a Retrieval Alert signalposted on a corresponding System Alert Summary Screen or on a alternate,alert-reporting mechanism.

In addition to predefined, default Interviews, a System in accordancewith the present disclosure may include an Interview customizing meansfor allowing a Medical Provider to define and request delivery of one ormore Custom Interviews; where these Custom Interviews may be appended toother Interviews sent by the System.

In accordance with one aspect of the present disclosure, if the Systemautomatically determines that one or more Interviews containing Alertsetting(s) have not been successfully communicated to (retrieved by)respective Patients, copies of such undelivered and Alert-containingInterviews are automatically sent to a Quality Assurance body for reviewand follow up.

Care-related information may be conveyed to and/or gathered fromPatients by the generation of one or more Interviews, where each suchInterview may include one or more separate Interview Dialogs.

(A) Topic Category: Test Result Reporting

A System in accordance with the present disclosure may include arule-based, Interview forming means that controls the formation ofInterview content based upon predefined rules which are consistent withmedical and/or test facility standards.

The System may use such predefined rules to automatically control whatcontent is placed in an Interview so that the Interview content that isspecific for (1) the Interview and/or (2) the Patient receiving theInterview Dialog. (For example, the Interview content may beautomatically augmented to include lay-person-friendlytest-interpretations in an Interview that initially contains just rawtest results). In one embodiment, the Interview Dialog content may beautomatically varied in response to pre-established, and/ortarget-centric, Patient Attribute values so as to accommodatecontext-based preferences of the patient. More generically speaking,Interview Dialog content may be automatically varied in response tocontent-controlling Attributes of one or more of the Person objects orof other Entities that are logically associated with the Interview.

The System may use predefined categorization rules to automaticallyidentify and categorize on a prioritized basis, Interviews that containabnormal test results and/or other important medical information. Suchcategorized Interviews may then be reported on a prioritized andcategorized basis to the relevant Medical Service Provider(s) by way ofan Alert Summary Screen (and/or an alternate, alert-reporting mechanism)such as that further described below. Such an Alert Summary Screen (orits alternate) may include follow-up selection means which allow theMedical Provider to immediately select and initiate a follow-upInterview in order to try to obtain more detailed information about theunderlying facts of the alert-containing, first Interview and in orderto thereby add the more-detailed information to the System database asmay be appropriate.

In one embodiment, Interview-editing means are provided so that theMedical Provider can edit a selected Interview. For example, a MedicalProvider may select for-editing, an initially-formed Interview that isto be delivered to a given Patient where the pre-edit Interview includesraw test results information and where the Medical Service Providerwishes to add some clarifying, further information. In accordance withthe present disclosure, the System may present pre-formattedinformation-clarifying Phrases which can be selectively added by theMedical Provider to one or more of the raw test results informationitems in the results-reporting Interview as may be appropriate so as tomake the delivered message more target-friendly.

A System in accordance with the present disclosure may also include anAddendum Phrase means which offers the Medical Provider an opportunityto add Addendum Phrases to an Interview which is to be delivered to agiven Patient. Such Addendum Phrases can include routinely-usable,generic text messages such as: “Please call in with your local PharmacyPhone Number so we can get you a prescription”. The latter AddendumPhrase could be checked off by the doctor if a lab-test result with apositive strep-throat culture comes in. If a blood test is performedafter an operation where minor blood loss is to be expected and theblood test shows a minor amount of anemia, the doctor could check off,for insertion next to that lab-report item, another Addendum Phrase suchas “You do not need to worry about this small deviation from normalvalues.” Thus the Medical Service Provider can quickly addpatient-friendly, clarifying text messages to raw, lab-results or othermedically-oriented informational transmissions before forwarding theseon for attempted delivery to the patient. This can help to reduce thenumber of times that patients call in with additional questions abouttheir results and can thereby reduce the communications work load of thedoctor's office (medical facility).

A System in accordance with the present disclosure may also include aRetrieval-Time Defining means which allows the Medical Provider tomanually set a Retrieval Deadline for the Interview or which allows theMedical Service Provider to elect to use a default Retrieval Deadlinethat has been predefined for the given Interview Dialog.

Once a, targeted-for-specific-patient(s) Interview has been initiated bythe Medical Service Provider, the System may begin to make automaticdelivery attempts of the initiated Interview to a corresponding one ormore Patients and the System may automatically record delivery-attemptand retrieval information pertaining to the System's interactions witheach corresponding Patient or lack thereof.

(B) Topic Category: Acute Illness Follow-Up

Typically a Patient is prescribed a treatment plan during an officevisit. A Medical Provider can anticipate a range of responses that willbe indicative of whether the prescribed treatment plan is performingadequately or not. Information regarding the Patient's subsequent healthstatus can be gathered by employing an automated interviewing mechanismcontaining a particular set of questions and responses. If a givenPatient's answer(s) to a particular one or more questions indicates thattreatment is not successful, the System should be able to automaticallydetect this and automatically notify the Medical Provider of thesituation Such an automated notification gives the Medical Provider theopportunity to initiate proper counter-actions promptly.

Introduction to Terminology Used Herein

A large number of specially marked, terms and phrases are used herein.Unless explicitly stated herein, words and phrases pertaining to themedical and computer arts have their ordinary meanings respectively aswould be understood by ordinary artisans in the respective fields. Thefirst letter in each word of a specially marked term or phrase iscapitalized herein. The below alphabetized introductions to thespecially marked, terms and phrases are not to be construed asestablishing any limiting definitions but rather as introductory remarkswhich may be further elaborated on in the more detailed descriptionsthat follow.

Account: When a user successfully logs into a System that conforms withthe present disclosure, the user typically then gains access to a set ofprivileges and also to a set of System Entities, where the accessibleEntities may be determined by further items associated with the usersuch as the user's Role and Attributes. The combination of theseprivileges and System Entities which the user gains access to whenlogging on, constitutes that user's Account. System Entities includedata objects which the associated user can interact with.

Addendum Phrase: These are phrases stored in a System Entity known as aTopic Entity. An Interview may be augmented with Addendum Phrases byinserting into the Interview, References to the Addendum Phrases of theassociated Topic. The Medical Provider in the Provider Screens can addthese references to a given Interview.

Advisement: A communication to a user that notifies the user that one ormore Interviews or Alert Information messages are part of an attempteddelivery and are awaiting acknowledged receipt. In one embodiment,Advisements are constrained so as to hold no confidential medicalinformation.

Agent Interview Instantiation Rules can include rules created for aHealth Maintenance Interview Assignment Agent. These terms will befurther explained in the detailed sections below.

Alert: An Alert is typically generated automatically by the System whenpatient-related data is outside of System specified norms. (Examplesinclude abnormal test results or a time deadline for message pickupbeing violated.) An Alert may be constituted by a deliverablenotification sent to given recipient(s) of a corresponding communicationwhere the notification is that of a high-priority circumstance that itis important for one or more of the recipients to be aware of. Amongstthe types of Alerts that are usable herein are: Information Alerts,Retrieval Alerts, and Interview Un-sent Alerts. Alerts that have beenreceived and acknowledged are considered inactive and no longer appearon an alerted Person's screen. When Alert information is sent fordelivery and retrieval, the System keeps track of it by recordingtracking information including status, and logging information (wheresuch logging information can include indications that certain users havelogged into respective Interview Dialogs associated with the Alertand/or have logged into the Alert information itself.

Alert (Information Alert): This may be a type of Alert whereininformation relating to a Patient's medical condition or circumstance isbeing communicated; e.g., to a Medical Provider (MSP) so that the MSPcan be quickly notified of medically critical information such as thePatients blood sugar or pulse rate being above a pre-defined threshold.

Alert (Interview Un-sent Alert): This may be a type of Alert wherein aSystem-supervising person such as a System-administrator is notifiedthat an Interview that was placed on the System was never sent within apre-defined period of time that had been set for it to be allowed toremain un-sent on the System and that it is therefore being deleted froma Delivery Scheduler maintained within the System.

Alert (others): In one embodiment, the System also has so-called,Blocked Interview Dialog Alerts. These may be constituted bynotifications to a supervisory Person such as a Medical Provider or anAdministrator that a Interview Dialog is not being delivered because theTarget Person has blocked the associated Topic or Application. These maybe considered as a type of Interview Un-sent Alert.

Alert (Retrieval Alert): This may be a type of Alert wherein asupervisory individual is notified that the Target of a given Interviewhas not satisfactorily accessed the Interview within a specified timeperiod. In one embodiment, if the Target subsequently retrieves theInterview for which the Retrieval Alert had been issued, the Alert iswithdrawn and canceled.

Alert Deletion Phrases: These may be phrases kept within a Topic andwhich are selectable by a Medical Provider when such an MSP is deletingan Alerted Interview and the MSP wishes to record the disposition of thealerted situation. Typical Deletion Phrases may include one or moreexplanations such as: “Patient contacted; situation handled;” “Patientnot contacted;” “Patient Refuses Follow Up.”

Alert Notes: Alert notes may include textual content included with anAlert when the Alert is delivered. In an embodiment, each Alert notecontains information that describes the circumstances underlying thedecision to generate the Alert.

Application: Each application entity may be constituted by at least anexecutable computer program and may further include program-associateddata where the latter may include one or more of: Channel DefinitionReferences, Prompt References, Greeting Logic definitions, GreetingPhrases, Application Attributes, Place Relationship Role Information,and People Relationship Role Information. The System may use suchprogram-associated data to perform functions of communication,Information delivery, Security Access, and granting Permissions. One ormore Applications may be hosted on a given System at any one time.Typical Configurations have plural Applications being simultaneouslyhosted. For example, a given System may be hosting three Applicationsthat respectively represent: 1) Medical Information Delivery for a firstHospital named ABC, 2) Medical Information Delivery and AppointmentReminders for a second Hospital named DEF, and 3) Emergency Recall forMedical Providers for Hospital GHI.

Application Attributes: These may be constituted by execution controlparameters that apply to or are used by a given Application to definethings such as the expiration time for the Application's Interviews, toindicate whether or not the Application is active on the System, and tocategorize the Application's Interviews priority relative to those ofother Applications.

AppServer: A component of the System that can interact with the SystemDatabase in order to provide the System's Scheduler Software with aprioritized list of Deliverable Interviews. Typically, the AppServer isused to deliver to Client Servers, requested information from the SystemDatabase.

Attribute Data: Data that further characterizes a given Entity. Forexample, a Person Entity might have a height Attribute, a set of weightAttributes at different dates, and an IsSmoker Attribute. Attributes maybe used to represent information. Also, rules (such as Dialog Rules andInterview Instantiation Rules) may use the Attribute values of Entitiesfor controlling a variety of Attribute-dependent functions. By way ofexample, a patients age, sex, and/or smoking habits may be used toautomatically determine if, and/or in what order certain Interviewquestions should be presented. A nonsmoker, for example, would not bepresented with a question like, “How many packs per week are you nowsmoking?”, whereas for a 50-year old smoker with chronic asthma thismight be one of the first questions presented in an Interview and theanswer may dictate what further Interview questions are automaticallypresented. By way of another example, a patient's age, sex, and/orheight may be used to calculate the corresponding normal range for anasthma peak flow test. The patient's actual breathing performance maythen be compared against the calculated normal range, and an Alert ofappropriate level may be automatically issued, and/or additionalquestions may be automatically posed depending on if, and how faroutside of the attribute-dependent, calculated normal range are theactual results of that patient. Some Attributes may be defined asfunctions of independent variables and the corresponding functionalrelationships may be stored in an Entity as well as specific Attributevalues corresponding to different values of the independent variables.Thus, e.g., a Patient's weights at various times may be stored orotherwise referenced by data kept in a Person Entity.

Attribute Definition: Attribute Definitions contain 1) definition andrequirement logic and 2) validation logic. Definition and requirementlogic determines whether or not a given Attribute must contain data fora particular role relationship with a given Entity type. Validationlogic helps determine the validity of a given Attribute value. Forexample, a numeric weight value cannot contain a dollar sign ($). In anembodiment, the System can employ rules to determine whether or not toaccept a supplied value as valid. For example, a person weight Attributecan use a rule that determines whether or not a weight value is validbased on the person's age. Thus, a 1-year-old child weight value of 100pounds would be typically deemed automatically as being non-valid.

Attribute Relationship Requirements: An Entity Relationship Role mayrequire the Entity to have certain Attribute values. Thus, e.g., aPerson Patient Role Relationship to an Application may require a NameAttribute for the Person. This is an example of an AttributeRelationship Requirement.

Channel: An information delivery means that is typically coupled(pre-fix wise or otherwise) with a Channel Context. Examples of possiblecommunication channels and their context prefixes include: home-phone,work-phone, personal-email, work-email, and emergency-phone.

Channel Address: This usually provides selective addressing informationfor identifying a given channel. For example, if the Channel is ahome-phone, then the Channel Address may be a telephone number (with orwithout area or country codes). If the Channel is a work-email, then theChannel Address may be a universally-usable or a network-specific emailaddress. In one embodiment such address data is stored with or directlyreferenced by the Person Entity.

Channel Context: As already explained, this data may be used as anInformation delivery classification modifier, such as “home” or “work”

Channel Definitions: These may provide supplemental characterizationsfor associated Channels and may be represented by parameter data thatare usable by the System and that can be referenced by Applications andDelivery Strategies for identifying specific details of the associatedcommunications channel. Examples of such informational parameters mayinclude hours of availability for the given channel and datatransmission type (such as voice, text, or HTML) that is usable over thegiven channel.

Channel Manager: This may be constituted by program logic that processesDeliverable Interview Dialogs received from the Scheduler for delivery.Such processing may include completing necessary fields in the receivedDialogs, verifying the validity of all completed fields, and thenpresenting the validated Dialogs to a specific Channel Type manager fordelivery. The Channel Manager may also be constituted by programs forprocessing Interview Dialog responses and Channel Requests andforwarding these back to the Scheduler for updating the Database.

Chart Note: Per conventional medical terminology, this may be aninformational note regarding a Patient and/or a Patient visit where thenote has been recorded into the System by a Medical Provider for lateraccess to aid in the care of the Patient.

Channel Request Handler: This subsystem may be constituted by one ormore programs in the System that receive Channel requests for morePending Dialogs to transmit and which pass these requests on to theInterview Chooser, where the latter can then supply these.

Channel Type: A main characterizing attribute of the informationaldelivery channel means such as telephone, web, email.

Chosen Dialogs: Dialogs that have been chosen for delivery at a giventime.

Database: A storage subsystem that holds the information and theprocedures typically used by the System to carry out its functions. TheDatabase information may comprise: Delivery Strategy information andlogic, Channel Definitions, Entity names and other Attributes includingInterview responses and other data, Roles and Role relationships, Alertdata and logic, Log-in logic and parameters, and other such data.

Data Maintenance: Routine data management operations such as dataarchiving, database integrity checks, and database cleaning and purgingprocedures.

Data Reaper: A portion of the System that is often made responsible for(1) gathering information to determine which Deliverable Interviewsshould be scheduled, and/or (2) handling data returned from DeliveredInterview Dialogs by the Response Handler. The Data Reaper may containand use the following modules for carrying out Interview Dialogdelivery: (1) Interview Chooser, (2) Channel Request Handler, and (3)Response Handler.

Deliverable Dialog: This is a kind of Interview Dialog wherein one ormore or all of the following is true: 1) Dialog Status is equal toPending, 2) the Interview Dialog belongs to an Interview withNeedsReview Property equal to ‘False’, and 3) the given Interview Dialoghas a next delivery time within the Dialog Delivery Schedule of theSystem taking into account any applicable InterDialog Time Gap.

Deliverable Interview: An Interview that has a Deliverable InterviewDialog.

Deliverable Interviews Manager: This module is responsible for gatheringand managing Deliverable Interviews from the Database as requested bythe Scheduler. It may also be made responsible for tracking andmodifying the state and properties of the Interview as the Interview isprocessed by the System. The Deliverable Interviews Manager may containlogic that prioritizes Deliverable Interviews for delivery to theScheduler.

Delivery Strategy: This broadly describes various kinds of data andinstructions that the System uses to deliver one or more PendingInterview Dialog(s) to a Target Person. The data and instructions maycomprise usable-channel identifiers, appropriate delivery timedefinitions for each channel, minimum and/or maximum number of attemptsper channel, prior communication strategy completion criteria,indications of whether or not Patient restrictions on delivery can beover-ridden, indications of whether or not a telephone hang-up orequivalent action causes cessation of delivery attempts, andspecifications for how security is to be handled (such as maximumpassword entries allowable over a given channel). A Delivery Strategymay inherit into itself, the strategy data or earlier other DeliveryStrategies that were being utilized prior to the given Delivery Strategybeing used. Delivery Strategies may also contain a progression listspecifying an ordered progression of strategies to be tried. Suchprogression strategies may include mandatory strategies and criteriathat must be fulfilled before a subsequent strategy can be executed.Each Interview Dialog in an Interview should contain at least oneDelivery Strategy.

Delivery Strategy Group: A specified set of Delivery Strategies that theSystem may use. Delivery Strategy Groups may be prioritized so that theyare used in a sequentially ordered progression by the System, with themore-likely to-succeed Delivery Strategies being attempted first andcomparatively less-likely to-succeed Delivery Strategies being attemptedlater, and perhaps not at all, depending for example on whether theurgency attributes of the communication are below predefined thresholds.Each Delivery Strategy Group may be respectively tuned to a particularkind of delivery mechanism. For example, a high-level emergency DeliveryStrategy Group could concentrate on use of cell phones, pagers and/orother recipient-targeting channels that have high likelihood ofcontacting even a highly mobile recipient. Such high-level emergencyDelivery Strategy Groups should have no limits on the channel open-timesof their respective communication channels. In contrast, a non-urgentDelivery Strategy Group may take into consideration the temporalbandwidths of the targeted recipient (e.g., the doctor is makinghospital rounds now and should not be disturbed for nonurgent matters)and such a non-urgent Delivery Strategy Group may therefore be more aptto use less-intrusive communication channels (e.g., email) because theconvenience of the targeted recipient is an overriding factor toimmediate retrieval of the message. A non-urgent Delivery Strategy Groupmay therefore have more reasonable, limited channel open-times, and/ormay rely more on less-intrusive delivery mechanisms such as telephoneanswering machines, email and web channels rather than on pagers, cellphones and the like.

Delivery Strategy Progression Requirement List—For a given DeliveryStrategy within a Delivery Strategy Group, such a ProgressionRequirement List may include a requirement that other DeliveryStrategies within the same Group but which are of higher precedence,must have each had a respectively-specified, minimum number of attemptscompleted before the given Delivery Strategy can be attempted.

Dialog Delivery Schedule: When an Interview is Instantiated; a DeliverySchedule is created for each of its Interview Dialogs. This can bespecified in terms of a range of delivery times or a delivery timewindow for each Dialog relative to the time of formation of theInterview or relative to another relevant sentinel event. A minimal timespacing between successive Interview Dialogs, the InterDialog Time Gap,can also be specified so that the information is delivered or obtainedfrom the Interview Dialogs at appropriate intervals. These factors mayinteract with delivery Channel parameters of the System and may therebybe used to schedule Dialog deliveries.

Dialog Question and Answer Presentation Rules: Such Rules can utilizeAttributes (such as Patient Attributes, Interview Attributes, and SystemAttributes) to determine which Phrases are presented to a user. In oneembodiment, these Attributes can be modified by the System via Interviewinput, Medical Provider input, and data uploading as well as Patient'sresponses during an Interview delivery.

Entity: The term “Entity” generally refers to any System object that canhave an Attribute. Typically, each given Entity can be madelogically-related to other Entities by assigning a Role to the givenEntity. Entities can comprise Persons, Places, Applications, Topics,Dialogs, Interviews, and even the object that references the System as awhole.

Entity Role Relationship Requirements—To establish a Role between aPerson and another Entity, the System might require the Person to haveparticular Attribute Values. In an embodiment, if a Person does not havea required Attribute value for establishing a given Role-Relationship toa particular other Entity Type, the Role-Relationship will be rejectedby the System. In another embodiment, if a Person does not have arequired Attribute value for establishing a given Role Relationship, adefault Attribute value will automatically be assigned to the Person soas to enable the establishing of the given Role Relationship. In anembodiment, Entity Role Relationship Requirements are based on EntityTypes. In an embodiment, Specific Entities can have specific Entity RoleRelationship Requirements.

Entity Type—This data item can identify the type of a respective Entitysuch as “Person” for a human being or an automated agent, or such as“Application” for a hospital/practice-specific set of interactions, orsuch as “Interview” for a specific communication between two or more ofidentified human beings and/or automated agents, or such as “Topic” fora specific set of Rules, Data and/or Logic under which an Interview ofthat Topic is to be instantiated.

Instantiation: Instantiation of an Interview occurs when the Interviewcontent and controls are made ready for delivery and retrieval. Thistypically occurs when Interview data is added to a Topic and Topic rulesare applied to form the deliverable Interview.

InterDialog Time Gap: Each given Topic Dialog except the last one in anInterview should have associated with it, an InterDialog Time Gap thatspecifies the minimum time until the next Interview Dialog in the sameInterview can be delivered after the given Interview Dialog has beendelivered.

Interview: Each Interview should be instantiated within a correspondingTopic so as to contain the data and logic that is to be used during thecarrying out of the Interview. An instantiated Interview typicallycontains Interview Dialogs and a Dialog Delivery Schedule withPriorities corresponding to each Topic Dialog in the Topic, Attributes,Information Alert Data, Retrieval Alert Data, Addendum Phrasereferences, Delegation Phrase references, Alert Deletion Phrasereferences, Role Information for the Persons and Places that have arelationship to the Interview, and Channel Delivery Attempt data logs.An instantiated and in-progress Interview may hold data derived duringinformation delivery to a Target, such as Patient's responses. The datain such an in-progress Interview can be used by other Entities that arerelated to the Interview based on the Role of each of the other Entitiesrelative to the Interview.

Interview Addendum Phrases: When a Medical Service Provider is reviewingor creating an Interview for delivery to a Target Person, the MSP mayselectively add Interview Addendum Phrases within the context of theencompassing Topic. The Interview Addendum Phrases selected by theMedical Provider may add further information to be used by the Target inprocessing the particular Interview.

Interview Chooser: The System may include various forms of Logic forcomputing the number of Deliverable Interviews that a given ChannelManager can accept in selecting which Interviews to try to deliver. TheChannel Manager typically determines which and how many Interviews canbe practically sent over each available Channel. The Interview Chooseris responsible for performing the final analysis on the deliverabilityof an Interview over a set of available Channels.

Interview Delegation Phrases: These phrases may be preselected fromwithin the Topic of a given Interview. Such Interview Delegation Phrasesmay be used by a Medical Service Provider to indicate to a lower ranked,Medical Assistant his or her desires when delegating responsibility overan alerted Interview to the Medical Assistant.

Interview Dialog: An Instantiation of a corresponding Topic Dialogformed when an Interview is formed from a Topic. It typically includesreferences to Persons, Attributes, and delivery mechanisms that will beused during the execution of this Dialog. It may also hold informationregarding the delivery history and status of the Dialog.

Interview Dialog Status: An Interview Dialog Status may be selected asone from the following nonlimiting list:

-   -   1) Pending—the Interview Dialog is awaiting delivery to        (retrieval by) a Target Person;    -   2) Expired—the Interview Dialog has been on the System for a set        period of time after which it is no longer eligible for        attempted delivery. A Database Cleanup and Archiving Agent can        remove such Dialogs from the System.

3) Delivered—the Interview Dialog has been delivered successfully to(retrieved by) a Target Person or, in one embodiment, the DeliveredStatus may further indicate if and/or when the Interview Dialog has beendelivered successfully to all the Target Persons in an associatedspecified Target Person Group

4) Not Delivered—the Interview Dialog has not been delivered to a TargetPerson.

5) Blocked—the Interview Dialog has been blocked from delivery by aparameter established at the Topic or Application level

6) Error—the Interview Dialog delivery was not completed because theSystem encountered an error condition.

In one embodiment, if an Application or Topic is blocked by a Person,i.e., a Person elects to have the System not have him or her as a TargetPerson for that particular Application or Topic, the Status of theDialogs of the corresponding Application or Topic are automatically setto “Blocked.”

Interview Instantiation Date: This can be the date and time that theSystem instantiates an Interview and assigns it for delivery to one ormore persons.

Interview Instantiation Rules: The System can use these rules to controlInterview formation when an Interview is created within the System.These Rules may contain conditions based upon Attribute values forEntities related to the Interview. These Rules may, among otheractions: 1) set certain data Attributes for the Interview, 2) setDelivery Schedule for the Interview parameters (such as PriorityValues), 3) set Alerts and Alert Notes, 4) set Retrieval Alertdeadlines, 5) set Interview routing, 6) set Interview delivery status,and/or 7) abort Interview delivery.

Media Type: This can specify communication protocols and types which maybe used when communicating over a given Channel such as HTML version,speech data, or text.

Medical Assistant This is a Person Entity Role. A Medical Assistant isan individual who assists a Medical Service Provider but does not haveprimary legal and/or medical responsibility for delivering Patient care.A Medical Provider may designate important Patient care activitiesincluding that of carrying out various communications to a MedicalAssistant after reviewing the medical data and situation. The MSPtypically instructs the Medical Assistant as to how the situation shouldbe handled. In one embodiment, certain types of Patient communicationactivities may be automatically delegated to a Medical-Assistant so thatspecific review of each instance of such activity by the MedicalProvider is not required.

Medical Provider or Medical Service Provider: This is a Person EntityRole. A Medical Provider is a person that has a relatively high level oflegal and/or medical-field-recognized responsibility for the Patient'smedical care. Medical Providers typically include physicians and thosepeople designated or empowered to have the responsibility to deliverimportant medical information and/or services to Patients, such as TestTechnicians, Specialists, and Medical Assistants.

Needs Review Property of Interview: If a given Interview has acorresponding NeedsReview Property set to ‘True’, the System shouldautomatically block delivery of all Dialogs belonging to such Interviewsuntil they are reviewed by an authorized MSP. A Medical Provider using areview mechanism such as the Provider screens and thereby understood tobe reviewing the Interview information can be empowered to change theNeedsReview Property to ‘False’. The System should automatically recordthe Person ID and Role and time when the NeedsReview Property is changedso that effective care-review audits can be conducted. Some Dialogs maybe automatically Instantiated with their NeedsReview Property=‘False’ soas to default to state that circumvents review. In one embodiment, aspecified one or more Medical Assistants may be authorized to alsoreview all or specified types of Interviews and to thereby change theNeedsReview Property to ‘False’ as may be appropriate.

Person Attribute Group—A group of persons who have one or more Attributevalues or range of values in common.

Person Entity: An Entity that is a human being or an automated agent andthat can have Role-based relationships to other Entities such as theSystem, Applications, Interviews, Topics, as well as other Persons.Roles for a Person Entity can include System Administrator, ApplicationAdministrator, Medical Provider, Medical Assistant, Patient, PrimaryCare Provider, and Test Technician.

Person ID Group: A group defined by a set of persons each of which hasan unique ID.

Phrase—Phrases may be represented by an ordered list of references topre-defined Prompts and/or Attributes. Dialogs may use pre-recordedPhrases to define content for Questions and/or Answers. Phrases as wellas groups of phrases can be used to define complete sentences orquestions.

Place Entity: An Entity that identifies a physical and/or logicallocation at which medical services are rendered, such as a clinic, anout-patient facility and so forth. Each Place Entity can have Role-basedrelationships to other Entities such as Applications and Interviews.Roles for this Entity include for example: Medical Facility and Clinic.

Porch: This is a Role-Specific security entryway, whereby a Person maylog into an Application with a Role using their Person ID and/orPass-code and/or other security ensuring measures (e.g., biometric) asmay be appropriate. A Person should only be granted access if theirPerson ID and Pass-code match and the so-authenticated Person has thegiven Role relationship to the given Application. For example, assume aPerson has only one Role relationship to Application A, which is MedicalProvider, and a different, singular Role relationship to Application B,which is that of being a Patient. Then this Person should not be enabledto log into the Application-B Medical Provider Porch, but should be ableto log into Application-A Medical Provider Porch. The said Person shouldhowever, be able to log into Application-B Patient Porch.

Priority: This a System-maintained value that the System can use todetermine the precedence of Interview Delivery for each given Dialog.Priorities may include: Application Priorities, Topic Priorities, TopicDialog Priorities and Person Priorities. In an embodiment, any or anycombination of the above Priorities can be automatically modified inresponse to a Patient's answers to individual Interview Dialog phrases.In certain embodiments, the precedence of an Interview Delivery may bemade a function of all the above-mentioned Priorities. In certainembodiments, an Application's Priority is given greater weight than allother priority types.

Provider or Medical Provider: See Medical Service Provider.

Response Handler: This may refer to one or more Programs in theScheduler that process information received from a delivered InterviewDialog and/or from an Interview whose delivery was attempted but notcompleted, where the Program(s) pass the received and processedinformation on to the Database.

Retrieval Deadline: This may refer to the date and/or time or otherevent-occurrence marker by which an Interview Dialog with a RetrievalAlert set should be accessed by the Target Person to avoid triggering aRetrieval Alert.

Roles: Roles may include those of System Administrator, ApplicationAdministrator, Patient, Medical Provider, Primary Care Provider, MedicalAssistant, and Test Technician. Roles may be used to definerelationships of Persons with other Entities, such as other Persons,Applications, the System, Topic, and Interview. A given Person may havemore than one Role in a given Application. The Roles between a givenPerson and Application typically define the subset of available Rolesfor the given Person for Entities belonging to said Application.

Role Based Security: The System may implement a type of Role-BasedSecurity for determining user permissions in the system. Under such aRole-Based Security paradigm, each Person's Role capabilities aregenerally confined to his or her Roles in the respective Application.Thus, e.g., if a Person is not mapped as a Medical Service Provider toApplication A (e.g., Alpha Hospital), then the Person cannot be mappedas a Medical Provider for an Application A Interview. The SystemAdministrator Role may specify a permissive Role for interacting withthe System Entity. Persons assigned the Medical Provider Role may beallowed to grant privileges to their account to other users such as toMedical Assistants. The System may use Roles to provide a means for agiven Person to have the ability to be associated with one or moreApplications. The Role a Person has may dictate which interfaces andresources are available to him or her. Therefore, a given individual mayhave one login user name and password and use this to access multipleApplications. The individual can then access and utilize select servicesfor each Application based on his or her Role(s) for the givenApplication.

Scheduler: This may be implemented with logic that selects a group ofprioritized Pending Interview Dialogs from the Deliverable InterviewsManager for delivery to Targets. These Pending Dialogs may be referredto herein as the Chosen Dialogs. The Scheduler may combine such ChosenDialogs with other Dialogs to the same Target Persons in the Database sothat several Pending Interview Dialogs may be delivered to the sameTarget in an Interview Dialog delivery.

System Entity: A System Entity may be comprised of Persons, SystemAttributes, Channel Types, Prompts, and Channel Definitions.Applications should be referenced to the System.

System Attributes: System Attributes may be comprised of informationused by the System such as data maintenance and archiving informationand default language specifications for System prompts.

Target: For purposes of an Interview delivery-attempt, the Target istypically the Person to whom a communication is being sent. In at leastone embodiment, this could be a Person with a Patient Role or a MedicalProvider Role.

Target Group—This can be a group of Persons to whom a same communicationis being sent for respective retrieval by each member of the group.

Topic: Each Topic should contain logic that is used for formulating eachof its Instantiated Interviews. A Topic can comprise a Dialog Collectionwhere the latter comprises Topic Dialogs which in turn comprise DialogDelivery Strategies, Alert Logic, Dialog Logic, Phrases, Rules, and/orAttributes, and/or Topic Interview Instantiation/Delivery Rules, List ofPersons who have blocked the Topic, Interview Addendum Phrases,Interview Delegation Phrases, Alert Deletion Phrases, and/or HealthMaintenance Topic Assignment Criteria. A Topic should be related to onegiven Application. A Topic may be used to create one or more Interviews.Thus, multiple Interviews may be Instantiated from a given Topic.

Topic Attributes: Topic Attributes may each include a priority valuethat assigns a relative priority to the associated Topic where theassigned priority is relative to corresponding assigned priorities ofother Topics. Each Topic Attributes may further include one or moredefault Topic prompt specifications, and/or a parameter that determinesif the Topic is active on the System or not.

Topic Category: This data structure may identify a category or type ofTopic such as Health Maintenance, Acute Illness Follow Up, SpecialistFollow Up, Test Follow Up, Custom Interview, or Test-Result(s)-Delivery.

Topic Dialog: Each Topic Dialog may contain delivery strategy setsand/or Topic Dialog logic and/or Phrases which may be used for definingand forming phrases, for adaptive content presentation, for controllingAlert information, and/or for establishing internal variables thatdirect question and statement delivery phrases. Interview Dialogs may beformed using these rules and data from Topic Dialogs when an Interviewis Instantiated from a Topic.

Topic Group: A set of Topics. By organizing Topics into Topic Groups, itis easier to select a particular Topic. In an embodiment, a Topic Groupcan have a name. This name may be used to give a generalization to theTopics that are in the Topic Group. An Example of a Topic Group mightbe, the Asthma Follow Up Office Visit topic-group, which, in anembodiment, may include a Topic for follow up for a mild asthma attack,a Topic for follow up for asthmatic bronchitis where an antibiotic wasprescribed, a Topic for follow up for asthmatic bronchitis where anantibiotic was not prescribed, and/or a Topic for follow up for severeasthma.

In accordance with the present disclosure, an automated mechanism may beconstructed and configured to provide a set of Topics (e.g., AsthmaFollow Ups) for a given Application (e.g., Alpha Clinic), where eachTopic contains at least one Topic Dialog, and where the Topic Dialog issuitably organized for managing a given medical diagnosis and treatmentplan. After a medical diagnosis and treatment plan has been formulatedfrom a corresponding one or more office visits, a Medical Provider or aMedical Assistant can instantiate an Interview based on a particularTopic to be sent to a Patient, where the Interview acts as a monitoringmechanism for assuring that the treatment plan is being carried out andthe patient is progressing as expected.

In accordance with the present disclosure, automated means can beprovided for formulating, sending, and ultimately delivering to anunder-treatment patient, an Interview that will contain one or moreInterview Dialogs where the latter can use automatic and interactivelogic to interview the Patient regarding his or her status following anoffice visit. The times and means of contact may be specified inDelivery Strategies as discussed below.

During the automated Interview Dialog, if a Patient response to a givenquestion is determined by the System to be indicative of a problem, theSystem may automatically set an Information Alert for this InterviewDialog and may thereafter automatically signal the Medical Providerrelated to the Interview of the situation by way of the MedicalProvider's Alert Summary Screen and/or by way of other Alert Reportingmechanisms. In this way, the System can automatically provide a meansfor the Medical Provider to be directly notified of the problem so thatfollow up efforts can be initiated rapidly.

During interaction with a delivered Interview Dialog, Patients who aredoing as medically expected should be able to indicate this by theanswers they provide to the System. The System should be able toautomatically record the Interview Dialog question and answer activityand store data representing such activity in its database for possiblereview by medical personnel if such review is warranted. InterviewDialogs may be structured in accordance with the present disclosure sothat the System is able to automatically receive quantitative responsesfrom respective Patients, such as peak flow measurements in asthmaticbronchitis, or pulse rate, or weight, and for the System to use suchresponses to (1) make comparisons over time for each respective patient,(2) compare the automatically-obtained, quantitative responses withcontext-based standards, (3) trigger the issuance of Information Alertswhere appropriate, and (4) automatically guide the question flow logicin view of already collected information about the patient.

(C) Topic Category: Follow Up for Specialty Referrals, AncillaryServices, and/or Tests

Commonly, a Medical Service Provider may want to obtain consultationwith a particular kind of specialist regarding a given patient or he/shemay want to request ancillary services or order tests for that patient,where the follow-on consultations, services or tests may call for themaking of additional arrangements beyond that of scheduling thepreliminary office visit. Appointments for such referrals often cannotbe made immediately, at the time of the preliminary office visit. Insuch cases the Patient is typically told that someone will call with anappointment in the future. This open-loop method of operating leaves thedoor open for a multiplicity of potential problems: (1) The referralrequest may be misplaced; (2) The insurance clerk may mishandle therequest (e.g., the biopsy request of a possible malignant skin lesionmay be scheduled for review in two months rather than right away as istypically called for in modern medical practice); (3) The Patient and/ornext-in-queue-MSP may not be able to be easily reached by the personswho are trying to schedule the follow up appointment(s) and thosepersons may simply give up trying; (4) The test lab fails to deliver therequested test results. These are just a few examples of the manyopportunities in an open-loop system (a system without a feedbackmechanism that assures the desired follow up actually takes place) wherescheduling and/or follow up communications may collapse and where thegood intentions of the initial Medical Service Provider are thwarted bydeficiencies in the communications infrastructure.

A System in accordance with the present disclosure may include means forautomatically instantiating a Test, or Consult-Referral Follow-UpInterview which is structured to prevent requests for tests,consultations, and the like from falling through the cracks in a busymedical practice. In one embodiment, such a Test, or Consult-ReferralFollow-Up Interview contains at least two Interview Dialogs: A first onethat contacts the Patient prior to the appointment to serve as anappointment reminder and a second one that contacts the Patient afterthe appointment to confirm the appointment or test was completed. If thesecond Interview Dialog fails to timely confirm that there was adequatefollow up, an Information or Retrieval Alert, as is appropriate, isautomatically generated by the System.

(D) Topic Category: Health Maintenance

Conventionally, Patients are reminded of home health monitoringinterventions during periodic office visits to their Medical Providers.For some chronic conditions these visits may occur every three to sixmonths (provided the patient doesn't miss such appointments). OftenPatients' monitoring between visits is poor.

A System in accordance with the current disclosure includes HealthMaintenance follow up means which can automatically schedule for thedelivery of Interview Dialogs that serve as Health Maintenancereminders, where the scheduling may utilize Rules and Delivery Schedulesresponsive to one or more Patient Attributes. The timing and/orfrequency of scheduled delivery can be determined by prespecified timingrules. In one embodiment this timing of delivery is made responsive tothe Patient's age and/or other Attributes and/or history of priorresponses. An example of such Health Maintenance, Interview SchedulingRules would be a reminder message that is automatically sent to Patientswhose Attributes indicate they have emphysema and they are older than 50and they have had pneumococcus vaccinations more than 5 years ago, wherethe reminder text includes an advisement to obtain a flu shot and apneumococcus vaccination. The Delivery Strategy rules for this messagecould, for example, call for delivery in the month of October and have aRetrieval Alert set for 7 days. Another example of a Health Maintenance,Interview Scheduling Rule could be one that instantiates the automateddelivery of a corresponding message to Patients with Diabetes Mellituswith Hemoglobin Alc values more than 8.0 percent where the messagerequests a home determination of their post-prandial glucose value. TheDelivery Strategy for this message could be set for periodicinstantiation every two weeks and a Retrieval Alert set for 7 days andan Information Alert set if the glucose value entered by the patient wasmore than 140 mgm percent.

A System in accordance with the present disclosure may include aProgress follow-up means that automatically, and usually periodically,instantiates one or more Interviews for gathering Patient quantitativedata from a respective patient so that the System can use such requesteddata to automatically monitor the Patient's progress. The lack of atimely response and/or receipt of responses that indicate deterioratinghealth status, where such indications may be automatically determinedfrom machine-implemented use of pre-defined, Progress follow up rulesshould trigger alerts. The Progress follow up rules may define when andwhat kind of Information or Retrieval Alerts should be issued to theMedical Providers who have a relationship with the initial, unansweredor bad-progress-indicating Interview. Typically, at least one MedicalService Provider is designated as the Primary Care Provider (PCP) for agiven patient within the bounds of a given Application, and by default,the System should establish an Alert-receiver relationship between thePCP and the Progress follow-up Interviews that are scheduled by theProgress follow-up means so that the designated primary care providerwill be alerted by default in the case where no other Medical ServiceProvider has been delegated responsibility for follow up and where theProgress follow-up Interviews indicate bad progress by the patient orare not answered by the patient within a pre-specified time window.

(E) Topic Category: Follow up on Patients who Fail to Keep ScheduledAppointments

A System in accordance with the disclosure may also automatically orsemi-automatically instantiate one or more Interviews under the TopicCategory of Missed Appointments. Typically the task of manually fillingin certain customizable message fields is delegated to a particularMedical Assistant who is responsible for keeping track of the Patientthat did not keep his or her appointment. Alternatively, Interviews inthis Category can be assigned to an automated, follow-up agent by havinga Data UpLoader of the System automatically upload a missed-appointmentfile, where the uploaded file contains information regarding the Patientwho was not seen for their appointment. The semi-manually orautomatically generated, Missed Appointment Interview requests thePatient to reschedule. In an embodiment, if the Missed AppointmentInterview is not retrieved, a Retrieval Alert is set for the Interview,such that the Medical Provider associated with the Interview will seethe Alert on the Alert Summary Screen or will learn of the failure bythe patient to cooperate via another, alert-reporting mechanism (e.g., avoice-based one). In one embodiment, if a Patient successively fails tokeep two or more appointments, an Information Alert is generated toindicate this heightened level of non-cooperation by the patient.

(F) Advisements

Sometimes, the reason that a patient has not responded to a first-sentInterview-request is because an answering-machine or another form ofmessage-intercepting intermediary has accepted the first-sentInterview-request in a manner that leaves the intended Target (thepatient) unaware of the fact that the Interview-request came in. Forexample, someone at home may inadvertently delete pending messages fromthe answering-machine or cancel the blinking of the pending-new-messageslight. A System in accordance with the disclosure may include aPending-messages Advisement means which automatically generates andtries to deliver an Advisement or notification signal (such as an emailor a pager notification signal) which will notify the Patient that he orshe has pending messages on the System that have not yet beenaffirmatively responded to by the patient or by a patient-delegate towhom the patient has delegated the authority to respond on the patient'sbehalf. (In some cases, an affirmative response may simply call for therecipient to press a touch-tone button, or to click-through to a specialweb page in order to affirmatively indicate they had gotten andunderstood the message. In other cases, the Interview delivery-attemptmay call for a much more elaborate set of responses.)

In one embodiment, Advisements are sent to all or pre-specified groupsof patients only if the unresponsive Patient appears to be notresponding to Interview-requests or messages that contain an alertsetting or an alert setting above a pre-specified threshold in aspectrum of alert level options. In yet a further embodiment, anAdvisement is sent to any one or to a member of a pre-specified group ofpatients only if the given Patient has messages with a particular alertstatus.

DETAILED DESCRIPTION

I(a). Exemplary Environment

Referring to FIG. 1A, a flow chart schematic is shown of an exemplaryenvironment 99 in which methods, systems and other aspects of thepresent disclosure may be practiced. It is assumed in the illustratedexample that a physician 20 (also referred to as an MD and shown wearinga hat labeled “MD”) has just finished seeing a given patient (P) 50. TheMD 20 now wants to have additional tests or procedures performed onpatient P. Let us assume the doctor wants X-rays taken of specific areasin the patient and wants the radiologist's reading (62) returned to thedoctor for consideration (26) no later than, say, three days.

This is easily said but turns out to involve a fairly complicated set ofinteractions when studied closely. The MD's mental intentions arerepresented by thought bubble 21. These thoughts 21 implicitly call forthe completion of a series of action items (83) even if the MD does notconsciously think about them. We will explore such action items as wefollow a trail of interactions developing clockwise around theillustrated clock face 24.

Soon after having the initial thoughts 21, the MD 20 may objectivelyinitiate the implied action items (83) by writing a short note on a slipof paper 22 and/or by verbally expressing the desired course of actionwith the speaking 23 of a few short words (“Let's schedule an upper GIX-ray for patient P”). The written and/or spoken expressions 22/23 maybe directed immediately to another person (e.g., patient P or nurse RN)or the expressions 22/23 may be indirectly routed towards an intendedrecipient (e.g., nurse RN) by for example slipping the hand-written note22 onto a to-do pile, or by sending the note as an email message 22 aand/or by dictating the spoken words 23 into a voice-recording machine23 a for subsequent retrieval by the intended recipient (e.g., nurseRN).

Just from this short introduction, one can see how things can go astray.What if the hand-written note 22 gets lost in the to-do pile? What ifthe dictation 23 a accidentally gets erased? The very firstcommunication delivery-attempt 25 (shown as a wide-bodied arrow) mayfail to complete and the MD's good intentions 21 may evaporate intouseless (or even harmful) inaction if things go wrong. Luckily for us,this is a very professional office and our MD 20 habitually knows toemploy multiple channels (e.g., tape 23 a, email 22 a) for his messagedelivery attempts because he instinctively understands that one or moresuch attempts may fail. Thus for purposes of moving the example along,we assume that the MD spoke (23) directly to the patient 50 and alsoscribbled the action plan onto a slip of paper 22 with instructions forthe patient 50 to give the memo slip 22 to the physician's medicalassistant (RN) 30 and with further indication that the nurse (RN) willtake care of scheduling the desired test procedure (e.g., X-ray).

Unfortunately, patient P is not as professionally minded about messagedelivery strategies as was our MD. A number of things can go wrong withthis indirect communication delivery attempt 25 a where the intendedtarget is actually nurse 30. The patient 50 may not understand theinstructions very well because, for example, the patient generallyspeaks a different language (e.g., Spanish instead of English) and/orthe patient is on medications or under duress and therefore has animpaired ability to understand. Even if the patient initiallyunderstands the instructions, he or she may forget by the time they getto the front desk to speak with the RN 30. We assume for sake of movingour example forward that these obstacles do not materialize. The doctoralso spoke directly 25 b with the nurse 30 and she proficiently got holdof the doctor's memo slip 22 before sending the patient 50 home.

We assume further in this example that the RN 30 decided to use atelephone 31 as her communications channel for trying to see to it thatthe MD's intentions 21 are converted into actions. After persistentlyringing the laboratory scheduler 40 a number of times, the nurse managedto get through and successfully deliver (35) her request for initiatingthe scheduling of an appointment for patient 50 and for letting thescheduler 40 know exactly what kind of procedure is being requested(e.g., an upper GI X-ray). The lab technician 40 is instructed toattempt to contact (45) the patient 50 and to thereby establish a dateand time on the lab's schedule 42 or when the X-ray procedure 58 is totake place.

Regretfully in our example, the lab technician 40 was given only onetelephone number for trying to reach patient P via the patient'stelephone 51. Upon calling that telephone number, the technician 40learns that the patient 50 has installed a telephone answering machine52 to intercept all incoming calls. In attempting to initiate a firstinterview 45 with the patient 50 for setting the procedure date, thetechnician 40 may have a large number of obstacles to overcome. First,there is the possibility that the telephone number dialed by thetechnician 40 is an incorrect one and the technician is leaving messageson a wrong answering machine rather than the one 52 that truly belongsto the patient 50. Second, it is possible that the patient's answeringmachine 52 is overfilled with messages or otherwise not working and thusis unable to record the technician's initial message. Third, the patient50 may not realize that there is a recorded message pending on hisanswering machine 52 because another family member may have alreadylistened to all the messages, deactivated the blinking “message pending”light and forgot to tell the patient 50 about the message and/or worseyet, erased the undelivered message. Finally, even if the patient 50 wastold about the message, the patient must remember and actually call backthe laboratory technician to thereby complete, what we refer to hereinas a “scheduling interview” 45. During the scheduling interview 45, theagreed upon date and time for the procedure should be recorded into thelaboratory's calendar 42. And hopefully, patient P will also accuratelyrecord the date, time and location for the procedure on his/her personalcalendar (not shown).

As the details of the above scheduling procedure (45) began to unfold,we have already begun to appreciate the idea that many obstacles cancome into play to block a successful completion of an “Interview”, inthis case, the scheduling interview 45. Flowchart-diamond 90illustratively presents two of these potential obstacles.Flowchart-diamond 90 asks whether the original message got through tothe targeted recipient (e.g., 50) by way of the chosen delivery channel(e.g., 51/52) and whether the target understood the initial message.Flowchart-diamond 92 addresses the further question of whether thetargeted recipient (e.g., 50) remembered about the initiation orcompletion of the communication attempt 45 so that the targetedrecipient (e.g., 50) can take the next expected action.Flowchart-diamond 94 addresses the issue of whether the target actuallyexecutes the remembered message and therefore calls back the labtechnician 40 to actually complete the scheduling 45 of the procedureand/or to actually go for the procedure 58. If something goes wrong withrespect to one or more of these flowchart-diamonds 90-94, the intentions21 of the initiating MD 20 may not be realized at all or within the timeframe (24) originally contemplated by the MD.

We assume that the lab (40/42) is professionally run and that as aconsequence, within a few hours or a day before the scheduled procedure58, the laboratory technician 40 will try (47) to contact the patient 50again to remind the patient of the scheduled appointment 42 so that thescheduled time slot is not missed. Just as in the case of theschedule-setting interview 45, the attempts to deliver and complete thereminder interview 47 may run into a number of obstacles. Theseobstacles can include those dealing with getting the reminder interview47 started by delivering at least an open-loop message to patient P(e.g., an automated recording, “You have an appointment at 3:42 PM . . .”) by way of a communications channel 51/52 that is likely to succeed inactually getting the message to the target 50. A more efficient remindersystem will close the loop by asking for acknowledgment by the patient(e.g., an automated recording, “Please press touch tone button 1 if youare coming, 2 if you need to cancel or 0 if you need to speak to anoperator”). Let us assume the lab 40/42 relies on an open-loop remindersystem which merely leaves a manually-generated voice message on thepatient's telephone answering machine 52. However, at the time thetechnician 40 tries (47) to remind the patient 50 about the appointment,the patient is in his car driving to work. The patient does not check inwith his answering machine 52 and completely forgets about theappointment that had been earlier scheduled during interview 45. Onceagain, the intentions 21 of the initiating MD 20 may not be realized atall or within the time frame (24) originally contemplated by the MDbecause of a communications problem. If the technician 40 had known tocall the patient 50 on the patient's cell phone (an alternate channel)at that time, perhaps the reminder attempt 47 would have been moresuccessful.

We assume in this example that the reminder interview 47 completedsuccessfully. The patient 50 not only got and understood (90) thecontents of the reminder interview, the patient also remembered them(92) and actually went for the appointment (94) at the scheduled time.Path 54 represents the patient's actions in correctly responding to thereminder interview 47 and/or the scheduling interview 45. Once on path54, patient P actually completes his or her part of the scheduling cycleand timely appears for the intended procedure 58. We further assume thatnothing goes wrong at the laboratory. The film is properly developed anddelivered to a radiologist 60. The radiologist timely sees the film andprovides a reading report 62. (As in the case of our doctor's (20)initiating request 22/23, the radiologist's report 62 may be dictatedand transcribed by a typist before being ready for delivery to the MD20.) In this particular case, the radiologist 60 notices (63) somethingsuspicious in the X-ray and the radiologist attempts (65) toexpeditiously notify the MD 20 that the reading is done (that statebeing represented by diamond 96) and that there is something suspicious(63) in the reading 62 which the doctor 20 should review (26) quicklyand perhaps act upon (28) immediately. If and upon receiving andreviewing (26) the reading 62, the MD 20 might wish to first consult(27) with the radiologist 60 before deciding what to do next (28).

It should be apparent from our above discussion that as the eventsinvolving the radiologist 60 unfold, all of the communication deliveryproblems discussed so far can again come into play as attempts (65) aremade to deliver the reading contents 62 to the doctor's office. Amongthe areas of concern are those of assuring that the doctor got andunderstood the message (90), remembered (92) among his or her many otherpressing tasks about the message and did something (94) about it, suchas reviewing 26 the reading and/or consulting 27 with the radiologist.There are further complications here, however. The doctor's office maybe deluged with many other lab results 75 coming in at the same time byway of the same or a wide assortment of different communications (e.g.,telephone, facsimile, e-mail, etc.). Within this volume of incoming anddiversified data, the doctor 20 may fail to spot the alert item 63 inthe incoming X-ray reading 62. Luckily for most patients, their labresults are usually negative. That makes the doctor's problem ofspotting a worrisome result all the harder because it is like trying tocatch a chance needle out of an emptying barrel of hay. It would bebeneficial to have a system and method (e.g., 87) for automaticallyfiltering through the deluge of incoming lab results 75 and forautomatically spotting and alerting the MD 20 as to a received andunusual test result (e.g., 62/65).

In one embodiment in accordance with the present disclosure, anautomated results-filtering mechanism 87 is provided which detectsnormal test results and directs such, detected-as-normal test resultsdirectly to corresponding Patients (50) and/or to a Medical Assistant(30) (where the latter could relay the results to the correspondingPatients) thereby bypassing the MD (20) and freeing him/her from havingto scan through a deluge (75) of incoming, normal test results. TheMD-circumventing system also helps to reduce the number of Patientscalling in inquiring about their results because in most cases, the testresults will have been automatically forwarded (delivered) to thePatient without physician or other human intervention as may be allowedunder the machine-defined rules for intervention less processing byoperations occurring under the System's and/or Application's (e.g.,Service Providing Organization's or subdivisions thereof, SPO's forshort) and/or Topic's auspices. On the other hand, if the automatedresults-filtering mechanism 87 detects an abnormal or otherwisenote-worthy test result (abnormal or otherwise note-worthy for thespecific Patient) it may send an Alert to the MD (20) indicating thatthis particular result (e.g., 62) appears to need review by the MD. Insuch a case, the note-worthy result may be held up and not automaticallysent to the Patient at least until the MD (20) has had a chance to firstreview (26) the result and optionally act (e.g., 26) upon it.

Also in an embodiment, an Alerts Summarizing mechanism (86, see alsoFIG. 10A) is provided which summarizes alerted situations and allows theMD (20) to conveniently check-in on the summarized alerts around theclock and by using different kinds of communication channels as may beappropriate for the circumstances the MD (20) finds him or herself in(e.g., on the golf course and can still check in via cell phone,wireless PDA, etc.). The Alerts Summarizing mechanism (86) also allowsthe MD to zoom-in (visually and/or otherwise) on details of the alertedsituation, where the latter, up-to-date details may be stored in aDatabase (88) maintained by one or more progress-monitoring/trackingand/or progress-managing computers 80 which are provided in accordancewith the present disclosure. Upon zooming in on details of a particular,alerted situation (e.g., 62), the MD may ask the System (80/88) toinitiate a set of action items (83) such as sending variouscommunications to the involved Patient (50) and/or to involved, othermedical service providers (30, 40, 60) at various time points and incoordinated fashion so as to establish a pattern of situation-followingup actions (e.g., scheduling more tests, more office visits, prescribingnew or modified dispensing of medications, etc.). Once the MD asks theSystem (80/88) to initiate such a set of action items (83), the MD canrely on the System to follow through and use intelligentdelivery-strategies for getting the desired communications through totheir respective recipients (e.g., 30, 40, 60) in timely fashion, and ifone or more, communication delivery-attempts does not succeed, the MDcan rely on the System to recognize the in-completion of task (95) andalert (85 a) the MD and/or other care-concerned persons (e.g., 30) ofthe failure to complete the expected action item on the action itemstask list (83). The so-alerted persons can then be asked by the Systemto follow up on the in-completion(s) and the System can track thosefollow ups to make sure they are completed.

Returning to our specific example of a note-worthy X-ray reading (62)being detected by the filtering system 87, being alerted to the MD andbeing reviewed (26) by the MD, it should be apparent from the foregoingthat, if upon such notice and review of the troublesome reading the MD20 wishes to consult 27 with the radiologist 60, the problems ofscheduling and establishing a Consultation Interview 67 can be equal tothose of a patient 50 trying to get in touch with a busy doctor. Likethe primary care physician (MD) 20, the radiologist 60 will typically bea busy person who is handling many readings and consulting with manyother primary care physicians at once. Accordingly, the scheduling andcompletion of a consultation interview 67 may itself be a complicatedmatter. Note now that we have primarily been following the progress ofjust a single patient (81) and the management of just a single testprocedure (58) from the time of the primary care physician's initiation22/23 of the detailed chain of events to the point where the processcomes full circle (if there are no vital communication or executionbreakdowns) and the MD 20 gets notice of and reviews 26 the requestedtest results. It should be remembered in all this that the MD 20probably has many other patients (82) and each may have their owncomplicated progressions of medical treatment steps and follow-ups. Thequestion then becomes how to manage such a complex system of attemptedcommunications and action-item completions in a user-friendly andefficient manner.

Note incidentally from FIG. 1A, that after the MD 20 decides on a nextcourse of action 28 (e.g., “We need to see patient P immediately!!”), anew round 29 of communication delivery attempts and completions begin.Ultimately, the doctor's new intention (21) may be to have the patientto call back (55) quickly and schedule a next visit with the doctor assoon as possible. There are many possible obstacles 98 to completion ofsuch a transaction. A number of these have been alluded to above. Suchcommunication obstacles are further reviewed in the sidebar 98′ of FIG.1A. The time-of-day (98 a) at which a communication delivery attempt(e.g., 45, 55, 67) is made may play an important role in the likelihoodof successful completion. At different times of the day and/or week, thetargeted recipient (e.g., 50) may likely be physically located in manyplaces 98 b other than the home. For example, the target may be drivinga car in heavy traffic, or may be busy at work, or may be in an airplaneon the way to a one-week vacation in a different time zone. These arejust of few examples of the situational permutations that may occur whena communication delivery attempt (e.g., 29) is made and the likelihoodof successful completion may be altered due to target-centric attributes(e.g., effective time of day for target, location of target, mood oftarget, etc.). There are also questions 98 c regarding what kind ofcommunication channels are likely to be readily available to the targetgiven the target's physical location and time of day. Does the targetedrecipient have a cell phone that is turned on? Does the targetedrecipient regularly check with his/her answering machine (52)? Does thetargeted recipient have a telephone pager or immediate access to theInternet? Also, there are questions regarding the recipient-centriccontext (98 c) in which the target will be receiving the attemptedinterview delivery. Is the target confused due to medications or otherfactors? Will the target be able to hear a voice-based communicationattempt if the target is temporarily deaf (e.g., due to an earinfection)? Does this particular recipient suffer from blindness? Arethere little children at home who cannot be trusted to pass a message onto an adult patient or guardian? Does the patient (50) know how tooperate a computer such that it would be wise to send a copy of themessage-pending notification by way of e-mail? These and many otherfactors may affect the delivery strategies that are used to try to get acommunication delivery (e.g., 29) effectively delivered to the intendedtarget (e.g., 50) such that it will be actually received, understood(90), remembered (92) and properly acted upon (94). At 98 e, it is alsoindicated that the contents of the attempted communication (29) may haveto be tempered depending on whether the selected communication channelis secure or not and whether the patient/target has agreed to havingconfidential information being sent over such a communication channel.

As should already be apparent from FIG. 1A, the present disclosurecontemplates the use of one or more progress-monitoring/tracking and/orprogress-managing computers 80. Such computers or like kinds ofprogrammably-instructable machines can automatically keep track ofdetails such as: (a) what specific communication channels are moresuitable for a given target at a given delivery-attempt time, (b)whether communication delivery-attempts were timely completed or not,and (3) what to do if a vital completion deadline is missed or analerted result (62/63) is received. Such computers (instructablemachines) can automatically and adaptively instantiate action item lists(83) and follow their progress so as to assure that a care-giver'sintentions (21) are timely fulfilled, or if not, that a responsibleperson is alerted and/or that follow up action (e.g., 28) is taken.

Computer deploy-able interfaces such as 81/82 and 85 may be respectivelyused to provide a feedback system 95 that checks for timely completionof instantiated action items 83 and/or to provide timely alerts aboutimportant completion milestones (e.g., 96—reading done) and/orimportant, missed ones of completion milestones (e.g., patient did notcall back 55 in response to delivery-attempt 29). This may be contrastedwith conventional medical practices wherein there is rarely any sort offeedback mechanism provided for tracking progress and checking on themany possible obstacles 98 that could interfere with, and finding waysto adaptively improve the likelihood of completion of the action items83 which the primary care physician 20 thought (21) that he/she wasinitiating at the beginning of the cycle. More specifically, and inaccordance with the present disclosure, automated machines and/ormethods (80) are provided for collecting information 81/82 from thevarious communication channels and notifying appropriate personnel ofcompletion of high-alert action items (e.g., 63) and/or of in-completion(e.g., 90) of certain actions within an expected time frame (24) so thatthe notified individuals can take corrective action. Doctor-centric (ormore broadly, Medical Service Provider-centric) user-interfaces (e.g.,85) are contemplated in which non-vital information is filtered out sothat the medical-service giver can focus on only alerted data 85 a(e.g., an abnormal potassium level in a just-run, blood test).Patient-centric (or more broadly, non-Medical Person-centric)user-interfaces (e.g., 84) are contemplated in which clarifyinginformation 84 a (e.g., addendums) is added to help a non-medicalrecipient (e.g., 50) better understand the status of medical care beinggiven directly to him/her or to a relative (or other such person) underhis/her care. For example, a patient 50 may wish to know, “Did my bloodtest results come back, and if so what do all the numbers mean?” Theclarifying information 84 a may say something to the effect of, “Don'tworry, for your age, sex, weight, etc. all numbers are within normallyexpected ranges and you do not have to come back and see the doctoragain.” Or it may say, “For your age, sex, weight, etc. the cholesterolnumbers are bit high. Click here to schedule a follow up appointment.”

In counterpart to the non-Medical Person-centric user-interfaced reports84 a, the disclosed feedback filtering means 87 can automaticallyintercept “normal” ones of the reports 75 for each of the patients 82,automatically insert the appropriate clarifying information withpersonal adaptations for the age, weight, etc. of the respectivepatient, and automatically begin a result-reporting Interview with thepatient 50, thereby bypassing the busy Medical Service Providers (20,30) while assuring that the patient will be adequately informed ofprogress in his/her medical care. The disclosed feedback filtering means87 can automatically intercept, “abnormal” ones (e.g., 62/63) of thereports 65175 generated for all the patients 82, and can automaticallyissue an Alert 85 a to the responsible care-giver (20) via theMSP-centric reporting interface 85. Means are provided for helping thedoctor to clarify to a targeted patient what the abnormal results meanand for helping the doctor's office to effectively communicate (29) withthe targeted patient in view of that patient's personal situation (e.g.,context attributes 98 a, 98 b, . . . 98 e).

The illustrated block diagram in FIG. 1A of the computer-automatedsystem 80-87 is intended to broadly convey a machine-implementedcarrying out of one or more aspects of the present disclosure. As thoseskilled in the computer arts know, there are many possible methods forinterconnecting components of a computer system in order to realize therepresented results. The schematically illustrated set of one or more,progress-monitoring and/or managing computers 80 may each include acentral processing unit (CPU) or other data processing means (e.g.,plural processors), and a system memory for storingimmediately-executable instructions and immediately-accessible data foruse by the CPU or by other processors. The system memory may take theform of DRAM (dynamic random access memory) and cache SRAM (staticrandom access memory). Other forms of high-speed memory may be furtheror alternatively used. Various system and network buses and/or links maybe used to operatively interconnect components of the computer system80-87. The computerized system may include non-volatile mass storagemeans 88 such as a magnetic hard disk drive, a floppy drive, a CD-ROMdrive, a re-writeable optical drive, or the like that is operativelycoupled or couplable to the system for transferring instruction and/ordata signals 89. Instructions for execution by the CPU's or otherprogrammable processors may be introduced into the system by way ofcomputer-readable media (88) such as a floppy diskette or a CD-ROMoptical platter or other like, instructing devices adapted foroperatively coupling to, and providing instruction signals and/or datasignals for operative use by the CPU or by an equivalent instructablemachine. The computer-readable media (88) may define a manufacture forcoupling to, and causing the system to perform machine-implementedoperations in accordance with the present disclosure. Instruction and/ordata signals are not limited to those conveyed by nonvolatile media(88). The computer system may include input/output (I/O) means forproviding interfacing with peripheral devices such as displays,keyboards, mice, and so forth. The I/O means may provide interfacing tocommunications networks such as an Ethernet network, a SCSI network, atelephone network, a cable system, a wireless link system or the like.Instructions for execution by the computer(s) and/or data structures foruse by the computer(s) may be introduced into system by way ofcorresponding instruction and/or data signals 89 that are transferredover the communications network(s) or otherwise introduced into thesystem. The communications network(s)—represented among other things by88—may therefore define means for coupling to, and the machine system80-89 to perform one or more operations in accordance with the presentdisclosure. The instructing signals and/or data signals that aretransferred through the communications network(s) for causing the systemto perform said operations may be manufactured and structured inaccordance with the present disclosure.

I(b). Hardware Architecture

FIG. 1B illustrates a simplified block diagram of a server 100 that maybe used in a System in accordance with the disclosure. Interactions ofthe Server 100 with various input and output devices are alsoillustrated. Server 100 may include an instructable data processor 112which can be coupled to a hard disk 120, a keyboard, mouse 116, and/oranother form of user interface (e.g., voice input, not shown) as well asto a video card and display 113, a network interface card 118, telephonycards and circuits 111, and random access memory (RAM) 114, where thelatter alone or in combination with the hard disk may contain systemsoftware 115 which provides instruction signals for instructing the dataprocessor 112 and/or other instructable data processing means (notshown) to carry out machine-implemented operations in accordance withthe present disclosure. It is to be understood that the instructionsignals within computer 100 may loaded into the computer through any ofa variety of means including, but not limited to, installation from aremovable data-conveying means such as a CD or DVD disk and/or thedownloading from a network (118) of instructing signals that are adaptedto cause the computer 100 to carry out machine-implemented operations inaccordance with the present disclosure. It is to be understood that thepresent disclosure contemplates not only the conveying of suchinstructing signals by way of various media, but also the conveying ofdata-structure signals that represent one or more data-structuresdescribed herein and which are useful for carrying outmachine-implemented operations in accordance with the presentdisclosure.

In one embodiment, the disk 120 stores data defining one or more of: anoperating system 121, a Java™ virtual machine 122, media files 123,e-mail middleware 124, medical information software 125, telephonymiddleware 126, hardware drivers 127, an XML parser 129, an FTP server130, instant messaging middleware 131, JDBC (Java DatabaseConnectivity)™ drivers 132, a web server 133, a SOAP (Simple ObjectAccess Protocol) server 134, a Database 135, encryption software 136,security certificates 137, and PHP (Personal Home Page) or Java ServerPages 138. In an alternate embodiment, one or more of the medicalinformation server programs and data may be stored at a remote locationand accessed via a network by the server 100.

Users of the System may access the Server 100 via telephony ports 101where the latter may operate with POTS lines 102 and/or Digital Lines103. Additionally or alternatively, users may access the Server 100 byway of LAN or WAN 106 means. The LAN/WAN 106 interface may interact withinput/output devices 110 where the latter may comprise PC's (personalcomputers) 107, Net PC's 108, Wireless Web Devices 109, and/or InternetPhones 105.

In an embodiment, Operating System 121 is Red Hat@Linux 7.1, VoiceBoards 111 is VoiceTronicx® V4PCI, Telephony Middleware 126 are VPBdevice drivers from VoiceTronicx®, and VPBapi, an open source programinterface for Linux OS to control the card, email Middleware 124. In anembodiment the instant messaging middleware is JXTA and Jabber™; Java™122 is JDK 1.3.1 ™ from Sun Microsystems©, JDBC™ Drivers and JDBC™ 2.1;XML parser 129 is Apache Xerces 1.4.3; the web server 133 is Apache HTTPserver; PHP 138 is open source PHP software; and email middleware isJavaMail™ API. JSP or Java Server Pages 138 may be implemented using anApache Tomcat Server.

In an embodiment, client applications, Medical Provider, and Patientscreens are built with Visual Basic runtime code, which parses XML Filesand presents and sends data via the SOAP exchange. Medical Providers canbe connected to the System by the Internet. In an embodiment, MedicalProviders and other users of the System may be connected by an intranetbehind a firewall and other users connected by the Internet. Encryptionsoftware such as Java Cryptography Extension™ and Java Secure SocketExtension™ may be used to help insure confidentiality of transmissionsoutside of the firewall.

A System client computer system may be operatively coupled to the Servercomputer 100 through the use of a web browser such as Microsoft'sInternet Explorer™. FIG. 2 illustrates a client computer 200 such as maybe used by a Medical Provider, a Patient, or another user of the Systemand its connection to a corresponding Intranet or the Internet. Theclient computer 200 comprises a processor 204 coupled to one or more ofa hard disk 210, keyboard and mouse 203, video card and display 202,network interface card 205, and random access memory (RAM) 201 where thelatter may contain additional System software 209.

Disk 210 in an embodiment includes an operating system 211, hardwaredrivers 224, encryption software 215, Visual Basic™ runtime software212, Java runtime software 230, web browser 214, and Medical Providerclient software 213. The web browser 214 may include means fordisplaying and/or editing a Provider-specific or Patient-specific webpage (233) using appropriate means such as HTML code 231 and/orJavaScript code 232 and/or other information presenting, editing and/ordefining data structures.

The illustrated Client Server 200 may interact with the System Servercomputer 100 through an I/O unit 206 that comprises an Internetinterface 207 and/or an intranet interface 208.

II. System Entities and Their Attributes

(A) System 301

FIG. 3A and FIG. 3B illustrate an object data architecture that may beused for the System. Block 301 represents the System Entity. The SystemEntity comprises System Attributes 302, Channel Types 303, SystemPrompts 304, Person Role Information for the System Administrator 315,and System Channel Definitions 305.

System Attributes 302 may comprise information that is utilized by theSystem such as the following: (1) database maintenance scheduleinformation, which gives information regarding frequency andcircumstances for updating the Database; (2) location of archived files,which gives the location(s) for the System to store archived files; (3)archive frequency, which specifies the System frequency of dataarchiving; and (4) default language for prompts if there is no otherlanguage specified for prompts in the Person, Interview, Topic, orApplication Entity Attributes, any of which override this SystemAttribute with precedence in the stated order. If no language preferenceis specified in any of these Entities, the default language used by theSystem is English.

Channel Types structure 303 contains data definitions of Channel Types.Channel Types can include delivery means types (such as telephone,e-mail, web, wireless phone, and WAP (wireless application protocol)devices.

System Channel Definitions 305 are definitions of communication Channelsthat the System may use to deliver Interviews. Each Channel Definitioncontained in System Channel Definitions 305 may comprise:

-   -   1) Time ranges which determine the availability of the Channel,    -   2) An indication of whether or not the Channel will handle        inbound or outbound initiated requests,    -   3) An indication of whether the Channel has the capability to        send notification or Advisement signals that indicate Interview        status,    -   4) An indication of which Media Type the Channel will support        (such as html version, speech data, text, etc.),    -   5) An indication of the maximum number of attempts allowed to        utilize this Channel over a given period of time,    -   6) An indication of the maximum number of security errors        allowed over a given period of time, and    -   7) An indication of the maximum number of disconnects (e.g.,        hang-ups) allowed before cessation of delivery attempts.

Some Channel Definitions may contain more data, such as minimum timeallowed between busy attempts. In an embodiment, a Channel Definitioncan support multiple Media Types.

System Prompts structure 304 contains Prompts, which may comprise Promptdefinitions and Prompt content. Each Prompt has content in at least oneMedia Type (such as text, sound file, html) and one language (such asEnglish, Spanish, Japanese).

The System Person Role Relationships for the System Administrator, 315may identify one or more people who have a Role of System Administratorto the System and Attributes for these Person(s) such as name andcontact addresses.

(B) Application 310

The instantiation relationship between the illustrated System Entity 301and the illustrated instantiation 310 of an Application Entity can beone-to-many (1-to-N). There is at least one Application Entity 310related to the System Entity 301. Each instantiated Application may havedifferent information stored in its respective data structures. Thisinformation may comprise: Attributes 308, Prompt References 307, ChannelDefinitions References 306, Place Role Relationships 316, Person RoleRelationships 311, Greeting Logic and Phrases 309, and/or a List ofPersons Who Are Blocked from participating in communications under thisApplication 312. As a concrete example, consider one Application asbeing Medical Group-A and a second Application as being Medical Group-B.At some point in time, doctor X and nurse Y leave Medical Group-A andshift their practices to Medical Group-B. At a later date, patient Z,who regularly saw doctor X asks that all his medical records be moved toMedical Group-B. In such a case, the List of Persons Who Are Blocked(312) of the Application for Medical Group-A might be modified toinclude Persons X, Y and Z.

Application Attributes 308 may comprise Attributes that the Applicationutilizes, such as indications of the maximum time an Interview of theApplication may remain on the System before it is archived, whether ornot the Application is active on the System, the priority setting forprocessing of the Application relative to other Applications, and thedefault language preference for the Prompts used in the Application. Ifthere is a language preference specified in the Person, Interview, orTopic Entity Attributes these override this Application Attribute in thestated order of precedence.

Application Prompt. References 307 may contain references to respectivesubsets of the System Prompts 304. As a concrete example, MedicalGroup-A may prefer to use one style of Prompts while Medical Group-Bprefers to use another.

Application Channel Definitions References 306 may contain references torespective subsets of the System Channel Definitions 305 of therespective Application.

Person Role Relationship 311 may include identity and other controlinformation for the following Roles: Application Administrator, MedicalService Provider, Medical Assistant, Testing Facility Personnel, andPatient. Information for these Roles should include the names ofPersons. Privileges and limitations of Persons related to theApplication may be defined in terms of their Roles. As a concreteexample, Medical Group-A may allow Medical Assistants to review anddismiss alert reports while Medical Group-B allows only persons of theMSP (doctor) Role or higher (Application Administrator) to review anddismiss alert reports.

Place Role Relationship 316 may comprise geographically-relatedinformation for Places related to the Application such as the following:Medical Clinics used by the Application, X-ray Facilities used by theApplication, Chemistry Laboratory Facilities used by the Application,Physical Therapy Facilities used by the Application, and Offices used bythe Application. Information for these Places may include their names,street or other mappable locations, telephone numbers, web addresses,and normal hours of operation.

The List of Persons 312 Who Are Blocked from this Application 312 mayreference Persons who have indicated they do not want to interact withthis Application. The System can use this information 312 to blockTopics and Interviews of this Application from communicating with theseblocked Persons. Greeting Logic and Phrases structure 309 may includeinformation that announces to Target Persons the name of theApplication. Also this structure 309 may contain log-in logic andsecurity and authentication protocols used by the Application. (E.g.,“This email from Medical Group-A is encrypted using the PGP standard.”)

(C) Topic 320

There can be one or more Topic Entities (320) related to eachApplication (a 1-to-N instantiation relationship). As a concreteexample, assume that Medical Group-B provides services relating to eye,ear, nose and throat. One Topic may contain Interviews relating to eyecataracts. Another Topic under the same Application may containInterviews relating to thyroid problems. The illustrated Topic Entity320 relates logically to the illustrated Application Entity 310. TopicEntity 320 may be comprised of Topic Attributes 321, Interview AddendumPhrases 322, Interview Delegation Phrases 323, Alert Deletion Phrases324, Dialog Collections 317, Health Maintenance Topic AssignmentCriteria 387, Interview Instantiation and Delivery Rules 326, and/or aList of Persons Who Are Blocked from this Topic 314. As a concreteexample: Mr. Jones decides to have his thyroid treated at a differentMedical Group but continues to use the current Medical Group-B fortreating his eye cataract. Mr. Jones would therefore not be blocked fromthe Application, but rather just from the thyroid Topic.

The Interview Instantiation and Delivery Rules 326 of the givenApplication may be comprised of one or more of the following:

-   -   1) Interview Validity Rules: These are Rules that set forth        requirements for the creation of a corresponding, Topic-related        Interview under Application policies and may include        restrictions on allowed Roles, Entity Attributes, and other data        objects that may be associated with the planned Interview and on        what valid values such other objects may be required to posses        before the Interview is allowed to be Instantiated. In an        embodiment, if certain valid data is not present for a required        Entity Attribute, Application-provided default values may be        used instead for such necessary data.    -   2) Interview Review Rules: Each Interview may have a property        called NeedsReview, which has a value such as ‘True’ or ‘False’.        Interviews with NeedsReview set as True are generally blocked        from being delivered to their Target(s) until the NeedsReview        property is changed to ‘False’ while being processed under one        of the Provider Screens or other Provider review mechanisms        allowed by the given Application so that the modified state        indicates that a Medical Service Provider or other        System-authorized Person has probably reviewed the Interview        before allowing it to go out. Some Interviews, such as those for        normal test result delivery to Patients, may have their        NeedsReview Property automatically set to False upon        Instantiation, so they do not need be reviewed by a Medical        Provider prior to being routed for Patient delivery. Other kinds        of Interviews may have their respective NeedsReview property        automatically set to ‘True’ upon Instantiation. Examples of such        latter Interviews can include those reporting tests with        abnormal results, where under the policies of the Application,        such results require Medical Provider Review prior to being sent        to Patients.    -   3) Delivery Schedule Adjustment Rules: Each Topic can have a set        of Topic Dialogs (329). Interview Dialogs may be formulated from        one or a composite collection of such Topic Dialogs. Each Topic        Dialog may have designated time ranges that are to be used to        create a Delivery Schedule for its corresponding Interview        Dialog. Certain Topic Dialogs may also have logic that specifies        InterDialog Time Gaps. An InterDialog Time Gap can work to        prevent confusing overlappings of Interview Dialog Deliveries        and can insure that a proper minimum time gap exists between        respective Interview Dialog deliveries. If a given Topic has        only one Topic Dialog, then it does not need to have an        InterDialog Time Gap. Typically, the last Topic Dialog listed in        a Topic Dialog Collection has no InterDialog Time Gap assigned        to it.    -   4) Priority Adjustment Rules: The Topic may have priority        Adjustment Rules that affect the Delivery priority of each        Interview's Dialog. These rules may be used to adjust priorities        in response to the Topic's priority, the priority of the        associated Application, and Attribute values. Interview Dialog        Target Responses may influence the Delivery priority of        subsequent Dialogs based on System rules. In an embodiment, such        rules may require any Interview Dialog with a potential for        including a Retrieval or Information Alert that might be sent        via a means that does not routinely notify the Target of the        receipt of a message (such as in an email account) to also be        sent by a different Channel (e.g., telephone) that actively        notifies a Target of an incoming message on the first channel.        Thus, at least two different channels may be called upon to        notify a Target of an incoming message that may contain a        high-priority Alert.    -   5) Dialog Collection Delivery Strategy Rules: The System tries        to deliver Interview Dialogs in a precedence order according to        their pre-assigned Priorities. Typically, an Interview Dialog        chosen for delivery on the basis of its Priority will have to        contend with other Pending Interview Dialogs that are targeted        for delivery to the same Target Person and as such the newly        added Interview may be packed or bundled with the other Pending        Interview Dialogs as available System capacity allows. These        other Pending Interview Dialogs may therefore be delivered at        the same time as the newly added one. Logic and rules that        pertain to this are discussed below under Methods of Interview        Formation, Scheduling, and Delivery.

Dialog Collection structure 317 holds classes of Topic Dialogs belongingto the Topic. One of these is a first Topic Dialog Class (Dialog-1) 327.Topic Dialog-1 (327) may contain its respective Topic Dialog-1 Logic,Phrases, Rules, and Attribute References 329 and Topic Dialog-1 DeliveryStrategy Set(s) 328, and Alert Logic 330. These Topic Dialog-1 Logic,Phrases, Rules, and Attribute References 329 may comprise:

(A) A selected subset of Phrases from the Application Prompt References307 and selected Entity Attribute references that may be usedindividually or compiled to automatically and/or manually formstatements, answers, and/or questions contained in specificinstantiations of this Topic Dialog.

(B) Rules and logic to formulate phrases and present questions,statements, and/or answers. These Rules may use Attribute values fromthe Entities related to the Interview Dialog-1 344 (such as Attributesfrom Medical Provider, Lab Tech, Clinic, and Target Patient) as well asAttributes from the Interview Dialog-1 itself to control how specificinstantiations of Interview Dialogs are generated. In an embodiment,some boiler-plate questions in a form Interview Dialog may be replacedby declarative statements.

Rules may be used to automatically generate new Dialog content that isresponsive to the Target answer choices. Such Rules may determine whenand how questions, answers, and/or informational phrases will bepresented in the Interview Dialog after certain Target responses arereceived.

An Interview Dialog can have prompts that adapt automatically to EntityAttributes and Rules. This serves to customize information content aswell as the behavior of the Interview Dialog. This can result in a verytailored communication that is appropriate to the Target's indicatedsituation. Also, an Interview Dialog may use the Topic Dialog's Rules tooffer prompts and phrases that are specific to the Target's language. ATarget Person's Language Preference Attribute may be used to determinewhich language prompts to use. If a Person doesn't have this Attributespecified under the Person's Attributes (for example, 361 or 371 of FIG.3B), then the Topic or Application Attribute, ‘Default LanguagePreference,’ may be automatically used in the stated order ofprecedence. If these are vacant, then a System language preference maybe used; if this is vacant, English may be used as the System defaultlanguage.

Alert Logic structure 330 holds Alert generation logic for thecorresponding Topic Dialog Class. Such Alert Logic 330 may automaticallydetermine, e.g., which Target responses automatically generateInformation Alerts, which Persons are to be targeted to receive theseAlerts, and the corresponding Alert Notes that will be contained in theautomatically formulated Alert messages. Alert Logic structure 330 mayalso include logic for automatically generating Retrieval Alerts andtheir associated information. Rules for sending information to theproper persons if a formulated Interview Dialog is automatically blockedfor some reason or if a “Not Timely Delivered” status appears for agiven Interview Dialog, may also be included in the Alert Logicstructure 330. Rules for automatically canceling Retrieval Alerts when,after a delivery deadline passes the Target Person nonetheless retrievesthe Interview Dialog may also be included in the Alert Logic structure330.

Topic Dialog-1 Delivery Strategy Set(s) 328 should contain at least oneDelivery Strategy rule for the given Topic Dialog Class. Each DeliveryStrategy rule may include one or more of:

-   -   1) A reference to a reference contained in Channels Definitions        References 306,    -   2) An indication of the minimum and maximum number of attempts        to be tried    -   3) Requirements regarding which other Strategies must be        completed before this Strategy can be used,    -   4) An indication of whether or not the Strategy can be cancelled        due to a delivery-obstacle event such as a hang-up or        equivalent, and    -   5) An indication of whether or not Patient's preferences        regarding the Channel are being taken into account when using        this Delivery Strategy.

The illustrated Topic Attributes structure 321 may include: (1) Anindication of whether or not the Topic is active in the system and/or(2) a Priority Value, which determines the importance of informationspawned from this Topic relative to other Topics.

Interview Addendum Phrases structure 322 holds a set of Phrases aMedical Provider may choose from, to add to an Interview that is beingformulated for subsequent transmission to a Patient so as to conveypatient-friendly, added information to that Patient. As a concreteexample, an Addendum Phrase may state, “Although this result is slightlyout of normal range, it is expected for your situation and should not beof concern.”

Interview Delegation Phrases structure 323 are a set of Phrases aMedical Provider may choose from to indicate desired action(s) by adelagee upon delegating the alerted Interview to another Person such asa Medical Assistant.

Alert Deletion Phrases structure 324 are a set of Phrases that a MedicalProvider may choose from to indicate for creating a recorded audit trailhow an alerted Interview situation was followed up on when deleting thatAlert from the Medical Provider's Alert Summary Screen (and/or otheralerting mechanism).

The List of Persons Who Are Blocked from this Topic structure 314identifies Persons who have indicated they do not want to interact withthis Topic. The System may use this information to automatically blockInterviews of this Topic from being sent to these Persons.

The Health Maintenance Topic Assignment Criteria structure 387 maycontain criteria used to automatically and/or semi-manually developHealth Maintenance Interviews such as, e.g., the Person's age Attribute,the Person's sex Attribute, and/or various other parameters determiningthe frequency and nature of periodic health examinations and/orinterventions (e.g., vaccinations) that are to be undertaken like PapSmears, mammograms, or prostate specific antigen tests. The HealthMaintenance Topic Assignment Criteria structure 387 may also containcriteria for automatically generating messages that make recommendationsfor flu shots. Structure 387 may also contain parameters for determiningthe frequency and nature of periodic health maintenance disease specificinquiries, recommendations, and the like.

(D) Interviews 340

Interviews are individual Instantiations under a respective Topic andthus there may be 1-to-N Interviews instantiated under a given Topic. AnInterview typically holds data specific to a planned communication witha Target Person (e.g., a Patient). An Interview data structure 340 maybe comprised of one or more of: Interview Attributes 358, an InterviewReview Property 352, Place Role Relationships: (e.g., from-Clinic) 353,Person Role Relationships: (e.g., from-Medical Provider, MedicalAssistant, Testing Facility Person, Patient) 359, Addendum PhraseReference(s) 354, Delegation Phrase Reference(s) 355, Alert DeletionPhrase Reference(s) 356, and Collection of Interview Dialogs 342.

Interview Attributes structure 358 may comprise: (1) values of variablesthat may pertain to more than one Interview Dialog and may apply toresponses obtained in the Interview, and/or (2) values of variables fortracking results of delivery of the Dialogs and the sequence of questionpresentations that are to occur during the Interview.

As already explained, each Interview can have a Review Propertystructure 352 called NeedsReview, which is set to “True” if theInterview must be reviewed by a Medical Provider before being sent to aPatient, and which is set to “False” if this is not the case. The valueof this Interview property is held in structure 352.

Place Role Relationships for Roles: (e.g. from-Clinic) 353 is a datastructure that holds Attribute information such as names and locationsof Places such as one identifying the Medical Clinic associated with theInterview.

Person Role Relationships: (e.g., from-Medical Provider, MedicalAssistant, Testing Facility Person, Patient) 359 is a data structurethat holds Attribute information relative to the Persons and Rolesinvolved in the particular Interview which may include such informationas the following for the each Role Person who is a generator orrecipient of the Interview delivery attempt:

-   -   Patient: Birth date, Age, Height, Presence of illnesses such as        hypertension, diabetes, Medication allergies, etc.    -   Medical Service Provider: Name, Clinics he or she works at,        Alert limits for high laboratory values of potassium, Alert        limits for peak flow values during asthma office visit follow        ups, etc.    -   Medical Assistant Name, Clinic worked at, Medical Provider(s)        works with, etc.    -   Testing Facility Person: Name, Name of Testing Facility,        references to panic levels for specific laboratory test results,        etc.

The Interview Addendum Phrases 354 is a data structure that holdsreferences to the phrases of Topic Interview Addendum Phrases 322 usedby the Medical Provider to add information for the Patient in processingthe particular Interview before it is sent for delivery to the Patient.

Interview Delegation Phrases 355 is a data structure that holdsreferences to the phrases of Topic Interview Delegation Phrases 323 usedby a Medical Provider in delegating the particular Interview if it isalerted and then delegated to a Medical Assistant or the like.

Alert Deletion Phrases 356 is a data structure that holds references tothe phrases of Topic Alert Deletion Phrases 324 that may be used by aMedical Provider in creating a recorded audit trail and upon deletingthe particular Interview from the System if it was alerted for follow upaction.

Collection of Interview Dialogs 342 (for Interview 340) is a datastructure that can comprise instantiations of plural Interview DialogClasses such as: Interview Dialog-1 344, Interview Dialog-2 341, andInterview Dialog-3 343. The illustrated Interview Dialog1 Instance (344)comprises Retrieval Alert Data 345, Information Alert Data 346,Attributes 347, Status 348, and Delivery Schedule with Dialog Gaps withPriorities 349, Logs 350, and Channel Delivery Attempts Information 351.

The Dialog Delivery Schedule with Dialog Gaps and Priorities 349 is adata structure that holds specific information relating to thisinstantiated Interview's Dialog Delivery Strategies including deliveryattempt times and/or priority and/or contact results. It may alsocontain information that is used to determine the order and timing ofthe Interview Dialog deliveries that involve this Interview Dialog. Inone embodiment, the Interview Dialog Delivery Schedule with Dialog Gapsand Priorities 349 is a data structure that may contain informationregarding

-   -   1) A Time Range when the instantiated Interview Dialog can be        Sent in reference to the time the Interview was Instantiated,        and/or    -   2) The relevant minimum time spacing between Dialogs of an        Interview (also known as the InterDialog Time Gap).        Information provided here may affect not only the delivery of        this Interview Dialog but also other Interview Dialogs of the        same Interview. In an embodiment, the Dialog Delivery rules may        be made responsive to information obtained in previously sent        Interview Dialogs of the Topic Interview.

Retrieval Alert Data 345 is a data structure that comprises the date andtime of formation of each Retrieval Alert associated with theinstantiated Interview Dialog, if any, together with the Alert Note andthe Person to whom the Alert is sent. Data regarding disposition of theAlert such as time of delegation or deletion and the Persons involved inthese actions may also be held here. Data regarding cancellation of theAlert, for example, by the Patient subsequently retrieving an Interviewthat triggered a Retrieval Alert, may also be held here. Informationspecifying review of handling of Retrieval Alert data by qualityassurance groups may further be held in the Retrieval Alert Datastructure 345.

Information Alert Data 346 is a data structure that comprises the dateand time of formation of each Information Alert associated with theinstantiated Interview Dialog, if any, together with the Alert Note andthe Person to whom the Alert was sent. Data regarding disposition of theAlert such as time of delegation or deletion and the Persons involved inthese actions may also be held here. Information specifying review ofhandling of Information Alert data by quality assurance groups may alsobe held here.

Interview Dialog1 Instance Attributes 347 is a data structure that maycomprise one or more of: (1) values of variables representing responsesobtained in the Interview, (2) values representing test resultsdelivered in the Interview, (3) values representing test resultsobtained in the Interview, and (4) values representing tracking resultsthat are generated by the System as it tracks an attempted deliveryand/or completion of the instantiated Interview Dialogs and/or thesequence of question presentations developed during the Interview.

Status 348 is a data structure that represents the status of theInterview Dialog. The Interview Dialog Status may be defined as being atleast one of the following:

-   -   (1) Pending, —by which is meant that the Interview Dialog is        pending delivery to the Target Person;    -   (2) Expired, —by which is meant that the Interview Dialog has        expired or exceed its designated time period to be on the        System. A Database Clean Up and Archiving Agent may be used to        automatically remove such Dialogs from the System;    -   (3) Delivered, —by which is meant that the Interview Dialog has        been delivered to its Target Person;    -   (4) Not Delivered, —by which is meant that the instantiated        Interview Dialog has not been delivered to its Target Person. An        Interview Dialog may be placed in the Not Delivered status by an        action from a Person which effectively blocks the corresponding        Application or Topic frorrm being deliverable to the designated        Target (e.g., patient Z has asked that all his thyroid-related        records be transferred to Medical Group-C); and    -   (5) Error—i.e., the Interview Dialog delivery was not completed        because the System encountered a communications link or other        error condition.

Logs structure 350 may hold information regarding successful accesses orattempts by various Persons to access a correspondingly-instantiatedInterview Dialog or information held within it. Logs structure 350 mayinclude identifying data which identifies one or more Persons accessingor changing data in the Interview Dialog and time stamps of suchactions. It may also comprise delivery information regarding how theInterview Dialog was transmitted, how the Interview Dialog was accessedand/or subsequently modified to thereby generate Interview Dialog Alertinformation, the times of Alert setting, and/or the times and Personswho accessed Alerts, and other information pertaining to the use andaccess of the Interview Dialog or information contained therein.

Channel Delivery Attempts Information 351 is a data structure that whichcan hold information detailing prior attempts at delivery for the givenInterview Dialog including the type of channel used, the time of eachattempt, and the results of the various attempts (e.g., successful, ontime, or not).

(E) Persons 399 and Places 398

The Persons data structure 399 shown briefly in FIG. 3A and then againin more detail in FIG. 3B can logically link each of the 1-N Interviews340 with one or more Persons under respective Roles such as theillustrated Person-A of FIG. 3B (360, having the Role of MSP relative toInterview 340′), Person-B (370, having the Roles of Patient and Targetrelative to Interview 340′), and Person-C (380, having the Role of TestLab Technician relative to Interview 340′). Other Persons within PersonsSet 399 may have no logical link and role relative to a given one ormore Interviews such as the exemplary one Interview 340′ shown in FIG.3B. Thus, Person-E (392), and Person-D (393) of FIG. 3B are shown ashaving no link and role with respect to Interview 340′. Persons who areassociated with the overall System and/or an Application under theSystem may be so-associated in defined Roles such as SystemAdministrator, Application Administrator, Medical Service Provider,Medical Assistant, Testing Facility Personnel, and Patient. A Person mayhave more than one Role in a System or under any one or moreApplications in the System and may have plural Roles in more than oneApplication in the System. Information which may be held in Personblocks such as 360, 370, and 380 is explained in more detail below.Places 398 in FIG. 3B is a data structure that represents Places such asClinic-A (397), Lab-B (396), and Office-C (395). Data held regardingClinic-A in block 397, for example, will be explained in more detailbelow.

The illustrated Interview 340′ of FIG. 3B is shown to be logicallyassociated with Person-A (360) who happens to be in the Role of MedicalProvider relative to the Interview 340′; with Person-B (370) who happensto be the Patient and the communication's primary Target Person in thecontext of Interview 340′; with Person-C (380) who happens to be aTesting Facility Person; and with Place-C (397) which for this examplehappens to be a Medical Clinic. Components of Interview 340′ are denotedsimilarly to those of 340 of FIG. 3A as described above.

The Person-A data structure 360 may comprise Chart Notes 362; Person-AAttributes 361; Person-A Delivery Strategy 364; Person-A ChannelAddresses and Channel Available Times and/or other Contact Information363; and/or a Person Role Relationship 365 which in the illustratedexample is the Role of Primary Care Doctor.

The illustrated Person-A Attributes structure 361 (Medical Provider)includes the Medical Providers name, clinic associations, specialty,specific personal limits at which to be notified for laboratory testabnormalities such as minimum alert levels for elevated potassium,parameters determining if he or she desires to be notified of Patientpeak flow values in asthma office visit follow ups, and otherinformation. It may also include a default language preference forPrompts and screens viewed (or otherwise retrieved) by the MedicalProvider while using the System; this preference over-rides languagepreferences expressed in similar Attributes for these areas at theApplication, Topic or System level. The Person-A Attributes structure361 may also hold information on how various Alerts are to be processedupon deletion from Person-A's account.

The illustrated Person-A Chart Notes 362 may comprise Chart Notes madeby Person-A which are relevant to this Interview 340′.

The illustrated Person-A Delivery Strategy structure 364 may includepreferences for parameters for follow up Interviews such astime-from-sending of first Interview Dialog for follow up for an officevisit for a mild asthma attack, channel preferences, and similarinformation.

Channel Addresses and Channel Availability Times and Other ContactInformation 363 is a data structure that can be comprised of the Channeldefinitions and their respective times of availability and preferencesfor contacting the given Person (Medical Provider), logic defining thosealerted situations for which the given Person (Medical Provider) desiresto be reached on any of these Channels and logic defining how alertedsituations are to be handled if he or she is not available, names andcontact means for back up responsible Persons (e.g., other MedicalProviders), and names and privileges of yet other Persons (e.g., medicalpersonnel) who have permission to access his or her account.

The illustrated Person Role Relationship for Role as Primary Care Doctorstructure 365 comprises information as to whether or not Person-A canfulfill the Interview-assigned Role of a Primary Care Doctor and whetheror not Person-A is the primary care doctor in terms of Interview 340′and in relation to the Interview-designated Patient, Person-B (370).

The illustrated block 370 of Person-B (Patient) represents the Target ofthe included Interview 340′. This Person-B (Patient) block can becomprised of: Person-B Attributes 371; Person-B Channel Preferences 374;Person-B Channel Addresses, Channel Availability Times and other ContactInformation 373; Person-B Chart Notes 372; and the Interview-designatedPerson Role Relationship 375 which is that for the Role of Patient.

The illustrated Person-B Attributes 371 of the designated Patient shouldinclude the Patient's name; date of birth; medical parameters such asheight; weight at specified dates; allergies to medications; currentmedications being taken; genetically related information regardingpredisposition to or protection from specific illnesses; geneticallyrelated information relating to deviation from usual drug metabolismpathway parameters; and other genetic information influencing medicalparameters; and whether or not the patient has specific chronic medicalconditions such as asthma, diabetes, or hypertension, and/or familyhistory of specific illnesses. The Person-B Attributes may also includea default language preference for Prompts and screens (and/or otherreports) viewed (and/or otherwise appreciatively obtained) by thePerson-B while using the System; this preference over-rides languagepreferences expressed in similar Attributes for these areas at theApplication, Topic, or System level.

The Person-B Channel Preferences structure 374 may include indicationsof the Channel types and respective delivery-attempt times which arepreferred by Person-B (the Patient) for contacts.

The Person-B Channel Addresses and Channel Available Times and otherContact Information structure 373 may include the addresses of thePerson's Channels and the respective, expected times of availability ofthese Channels.

The illustrated Person-B Role Relationship for the Interview (375) showsthat Role as being one of Patient and this data structure 375 maycomprise the name of the Patient's Primary Care Physician, insuranceinformation and limits on insurance coverage, and information such aswhether or not a referral visit is necessary before the Patient sees aspecialist.

The Person-B Chart Notes 372 may include all active Chart Notespertaining to Person-B made by Medical Provider, Person-A In anembodiment, the Chart Notes 372 include all Chart Notes for thisPerson-B Patient as made by Medical Providers within the System otherthan the Medical Provider who Instantiated this Interview 340′. Furtherin an embodiment, the Chart Notes 372 may include Chart Notes for thisPerson-B (Patient) as made by Medical Providers other than the MedicalProvider who is Person B's primary care provider.

Block 380 for Person-C is that of a Testing Facility worker and itaccordingly comprises Person-C Attributes 381, Person-C DeliveryStrategy 384, Person-C Chart Notes 382, Person-C Channel Addresses,Channel Availability Times, and other Contact Information 383, andPerson Role Relationship 385 which in this case is theInterview-assigned Role of Testing Facility Person.

The Person-C Attributes 381 may comprise a Testing Facility name, clinicassociations, limits for test values beyond which Alerts are sent to aProvider, retrieval deadlines for these Alerts, normal ranges for testresults, and standard sets of tests. Person-C Attributes also includes adefault language preference for Prompts and screens (or other datareporting means) viewed or otherwise appreciatively obtained by Person-Cwhile using the System; this preference over-rides language preferencesexpressed in similar Attributes for these areas in other Entities of theSystem.

The Person-C Chart Notes 382 may be comprised of Chart Notes of theTesting Facility Person that relates to this Interview and/or the of theassociated Medical Service Provider(s). The Person Role Relationship forthe Role of Testing Facility Person (385) may comprise information suchas the testing facility Name, testing facility limits for panic valuesfor certain tests, and testing facility paradigms for contacting MedicalProviders in the event of a panic value for a test.

The Person-C Delivery Strategies 384 may indicate Channels, times, andother information relating to how Person-C is able to receive and/ordeliver information relating to this Interview 340′.

The Person-C Channel Addresses, Channel Available Times, and otherContact Information structure 383 may indicate addresses and times forthe Channels available to Person-C for communications used for thisinterview.

Within the Places structure 398, Clinic-A 397 is a Medical Clinicassociated with Interview 340′ and it has a corresponding Clinic-AAttributes structure 394. These attributes 394 may includecharacteristic of the clinic such as name, contact addresses, andlocation and rules the Clinic has relating to the informationcommunicated in Interview 340′. The latter rules may comprise rulesrelating to quality assurance matters, normal or abnormal limits fortests, and privileges for handling alerted Interviews.

III. Method of Interview Formation, Scheduling and Delivery

FIG. 4 and FIG. 5 illustrate a method of Instantiating, scheduling anddelivering Interview Dialogs in an embodiment according to thedisclosure.

(A) Structural Components:

FIG. 4 illustrates the interactions and relationships that may takeplace in accordance with the present disclosure between a SystemDatabase 433, a System Engine and Interface Programs of an AppServer425, a Scheduler 450, Channel Managers 410, Medical Provider Screens401, Administrator screen 405, a Pattern-Driven Interviews InstantiatingAgent 432 (which is also at times referred to more under a more specificrole herein as a Health Maintenance Interview Assignment Agent), anInterview UpLoader 404, Administration Tools 434, Report Emailer 431, anAdministrator Browser Interface and Report Browser Interface 421, and aDatabase Cleanup/Archiving Agent 430. Also illustrated is a Web Server412 that can interface between the Administrator Browser Interfaces andthe XML Connector 427, and the Advisement Sender Agent 460.

A Database 433 in one embodiment, uses Postgres 4.1™ Database Softwareto aid in interacting with other components of the System. The Postgres4.1 Database Software is available from PostgreSQL, Inc., P.O. Box 1648Wolfville, Nova Scotia, Canada.

The Medical Provider Screen Clients 401 may comprise Medical InformationDesktop Clients 403 and Medical Information Handheld Clients 402.

The Administrator Browser Interfaces 421 may include one or moreAdministrator Screens 422 and/or one or more Report Recipient LoginScreens 423.

The AppServer 425 may be constituted by an XML Connector 427 throughwhich XML-compatible (Extensible Markup Language protocol compliant)Interviews may be uploaded to the AppServer 425 for use by theConnection Manager 426 which conveys data from the XML Connector to andfrom the Engine 428, and the Database Interface 429. The DatabaseInterface 429 is an interface through which the Engine interfaces withthe Database 433 and/or the Database Cleanup and Archiving Agent 430.

The Report Emailer 431 may be comprised of a Report Scheduler 437, anEmail Manager 436, and an Emailer, 438. In an embodiment, reports canalso be sent as web or intranet files or by way of other report contentdelivery means as may be appropriate.

Channel Managers 410 for managing Interview Communications may becomprised of specific Channel-type managers and corresponding clientsincluding but not limited to: a Pager Manager 406 and Pager 440, anEmail Manager 407 and Email-er 413, a Wireless Manager 408 and CellPhones 414 and/or wireless Personal Digital Assistants (PDA's e.g. PalmPilots™) 415, an Instant Messenger Manager 409 and AOL™ 416, Yahoo™ 417,Microsoft Internet Explorer™ 418, ICQ 419 or like Instant MessagingSearch Engines, a Telephony Manager 411 and Telephony Subsystem such asa Voice Tronicx™ or Dialogic™ System 420 (where the latter may berespectively obtained from VoiceTronix, 63 Reynell Street, Kilkenny5009, Australia and Dialogic Corporation, 1515 Route Ten, Parsippany,N.J. 07054, USA), and a Web Browser 451 and Web Client 452.

FIG. 5 illustrates some further detailed structures which may beprovided in the Scheduler 450, AppServer 425, Database 433 and a moredetailed view of a Channel Manager 501. The illustrated Channel Manager501 is one of the many Channel Managers noted in 410 that can interactwith Scheduler 450. Channel Manager 501 comprises a Channel Connection508 that interacts with a Connection Handler 513 of the Scheduler andChannel Manager Software 507. Queues 504 may be comprised of anInterview Dialog Requests Queue 503 and/or Interview Dialog Responsesand Channel Requests 506. Both these queues may interact with theChannel Manager Software 507 and the Dialog Manager 502. The DialogManager can responsively supply a completed Interview Dialog 505 to theillustrated Channel Specific Logic 510 for transmission to the Target.Logic 510 may be used to establish a connection to a correspondingtransmission client 511 (e.g., which handles phone lines or othercorresponding communications channels).

The Scheduler 450 may be comprised of Queues 514 that interact with theConnection Handler 513 and the DataReaper 515. Queues 514 may holdExecutable Interviews 516, Channel Requests 517, and Interview DataWaiting for Response from a Channel Manager 518. The DataReaper 515 maybe comprised of an Interview Chooser 519, a Channel Request Handler 520,and a Response Handler 541. Executable Interviews 516 may be suppliedfrom the Interview Chooser 519. Channel Requests 517 may be delivered tothe Interview Choose 519 via the Channel Request Handler 520. TheInterview Dialog Data Waiting for Response data structure of the ChannelManager 518 should be combined with the corresponding Interview Dialogresponse data when an Interview is completed and forwarded to theResponse Handler 541 and thence via the AppServer 425 to the database433 for retrievable storage in the database.

The Scheduler 450 can interact with the AppServer 425 via theillustrated XML Connector 427. These couplings allow the Scheduler 450to interact with the illustrated Database Access Layer 525 through theConnection Manager 426.

A Deliverable Interviews Manager 523 may be included in the Engine 428part of the AppServer 425 as well as web support and client protocols.These may also interact with the Database Access Layer 525.

As is illustrated, various components of the AppServer 425 can thereforeinteract with the Database 433. The Database 433 can hold datastructures representing Delivery Strategies 531, Channel Definitions533, Persons 534 and/or Interviews 535. The exemplary set of Interviews535 may contain a first Interview-A (536) and a second Interview-B (537)among others. As seen, Interview-A, may contain corresponding Alert Data538 and a first Interview Dialog-A1 (590), a second Interview Dialog-A2(540), and a third Interview Dialog A3 (539). Interview B may similarlycontain respective Alert Data 561 and a first Interview Dialog-B1 (563),a second Interview Dialog-B2 (564), and a third Interview Dialog-B3(562).

(B) Interview Instantiation and Activation:

Referring to FIG. 4, Interviews may be loaded into the System, orinstantiated, via at least three ways:

-   -   [1]. Direct upload via UpLoader 404;    -   [2]. By way of actions of the Pattern-Driven Interviews        Instantiating Agent (i.e. when acting as a Health Maintenance        Interview Assignment Agent) 432; and    -   [3]. By way of actions undertaken when using the Medical        Provider and/or Medical Assistant Screens 401.        These are discussed in turn below:

[1]. When Direct upload via the UpLoader 404 is used, the UpLoaderprocesses data by: (A) reading a file or (B) inputting data via adata-input stream. In one embodiment, the UpLoader input data should bein XML format, wherein there can be separate tags assigned for eachUpLoader Command. The UpLoader Commands may comprise one or more of thefollowing:

i. Instantiate Interviews for a given Application,

ii. Add Persons to the System,

iii. Add Places to the System,

iv. Establish or Modify a relationship between a Person and an Entity,

v. Establish or Modify a relationships between a Place and an Entity,

vi. Establish or Modify Attributes for an Entity,

vii. Delete an Entity,

viii. Add an Entity,

ix. Add an Application,

x. Add a Topic to an Application.

In one embodiment, more than one UpLoader can exist for a given System.Each such UpLoader should be able to support any subset of theabove-described UpLoader Commands. Moreover, in the one embodiment, morethan one UpLoader Command can exist in an Upload Data Stream or anUpload File. For example, an Upload File might include the followingUpload-Commands: to add a plurality of People, one Upload Command toCreate an Interview, and ten Upload Commands to change Attribute Valuesfor various Entities in the System.

Examples of XML pseudo-code of upload commands follow.

(a) Upload Command: Instantiate Interview:

An example of an Instantiate Interview Command is shown immediatelybelow. Note that if there is an error, all sub-parts (e.g., Persons tobe added) are not added:

<InstantiateInterviewAppID=“San Jose Medical Info Server” Topic=“TestResult Delivery-Cholesterol ”>   <Attributes>     <Attribute LDLVal =“165”/>     <Attribute HDLVal = “40” />     <Attribute TotalCholVal =“194” />     <Attribute AccessionNumber =“45454” />   </Attributes>  <AddPersToInterview Role=“Patient”>     <Attribute FirstName=“Jay” />    <Attribute LastName =“Thompson” />     <Attribute ID=“23222” />    <Attribute DOB=“12/22/93” />     <Attribute PersSex=“Female” />    <CommunicationChannel ID=”Home Phone” Address=   ”408-721-8222” />  </AddPersToInterview>   <AddPersToInterview Role=“Medical Provider”Default Phone =   “406768-5645” >     <Attribute FirstName=“Mark” />    <Attribute LastName =“Jillians” />     <Attribute ID=“299933” />  </AddPersToInterview>   <AddPersToInterview Role=“Lab Tech”>    <Attribute FirstName=“Sam” />     <Attribute LastName =“Houston” />    <Attribute ID=“293983” />   </AddPersToInterview>  <AddPlaceToInterview Role=“Clinic”>     <Attribute Name=“Main Clinic”/>     <Attribute ID=“23” />   </AddPlaceToInterview></InstantiateInterview>

The above example of the Instantiate Interview XML pseudo-code loads anInterview for delivering lipid test results for the Application namedSan Jose Medical Information Server. The values of the components of thelipid test are loaded in the first section; the Patient data Attributesincluding patient name (Jay Thompson) is next loaded, followed by theMedical Service Provider Attribute information for Dr. Mark Jillians,the laboratory Attributes information under the name of Sam Houston, andthen the medical clinic Attributes information.

Suppose that upon an uploading of this data to the Instantiate theInterview object from the Topic “Test Result Delivery-Cholesterol”, theSystem automatically compares the uploaded test result values with thenormal ranges in the System associated with the Lab Tech named SamHouston and finds the LDL level outside of the corresponding normalrange. As a consequence, the NeedsReview Property of the resultingInterview is set to “True,” and a synopsis of the Interview is sent tothe Medical Service Provider's Alert Summary Screen. An example of suchan Alert Summary Screen (for a different doctor) is illustrated in FIG.10. Also a Retrieval Alert is set for the Interview with a defaultRetrieval Deadline, and a default Priority is given to the InterviewDialog responsive to the LDL test result being abnormal. The DeliveryStrategy Schedule for the Interview is also set by the Topic rules. As aresult, Dr. Mark Jillians should be alerted that an abnormal LDL testresult has been received. If Dr. Jillians does not timely retrieve thisalert, another responsible person will be notified of the past-duealert.

The logic used for the UpLoader to Instantiate Interviews for aparticular Application can use the following to process the UploadCommand:

-   -   i. Read Upload Command Data into memory; if no more input        exists, exit process    -   ii. Locate Topic from which to Instantiate the Interview    -   iii. Load Interview including Dialog Attributes into memory    -   iv. If the Topic Upload Rules (Interview Instantiation Rules)        don't allow Instantiating the Interview, abort the Interview        Instantiation and go to Step i.    -   v. Use the Topic Rules to        -   a) Set Alerts, if any.        -   b) Set Priorities for each Interview Dialog for the            Interview        -   c) Set the Delivery Schedule for each Interview Dialog for            the Interview        -   d) Set the NeedsReview Property of the Interview.        -   e) Create relationships with Persons to the Interview    -   In an embodiment, Topics that are uploaded this way include        appointment reminders and test result deliveries.

(b) Uploading Persons into the System:

-   -   The process to upload Persons into the System may be comprised        of the following steps:        -   i. Read input record into memory; if no more input exists,            exit process        -   ii. Read Attributes for Person        -   iii. Create Person Entity with the read Attributes            An example of the commands to do this is:

<AddPers Role=“Patient”>   <Attribute FirstName=“Bill” />   <AttributeLastName =“Ton” />   <Attribute ID=“23982” />   <AttributeDOB=“12/22/50” />   <Attribute PersSex=“Male” />   <AttributePersLastFluVac=“10/11/00”/>   <Attribute PersDiabMellitus = “Yes”/>  <Attribute PersLastEyeExam=“5/9/00” />   <Attribute PersMedAllergy1=“Penicillin”/> </AddPers>

The-above XML pseudo-code loads a Person with a Patient Role into theSystem. The Person Attributes including first name, last name, IDnumber, date of birth, sex, date of last flu shot, whether or not thePatient has Diabetes, the date of the Person's last opthalmologicalexamination, and a medication allergy should be loaded successively intothe System in the order given.

(c) Uploading Places into the System

The process to upload Places into the System may be comprised of:

-   -   i. Read input record into memory; if no more input exists, exit        process    -   ii. Read Attributes for Place    -   iii. Create Place Entity with the read Attributes        An example of the commands to do this is:

  <AddPlace Role=“Clinic”>   <Attribute Name=“Clinic B” />   <AttributeAddress1=“2347 Oakville Dr.” />   <Attribute Address2=“San Jose” />  <Attribute Address3=“CA” />   <Attribute Phone =“330 678-9800” /></AddPlace>

-   -   This XML pseudo-code loads a Place, Clinic B, with a Place Role        of Clinic into the System. The Place Attributes loaded include        name, address, and phone number.

(d) Modify Relationship Between a Person and an Entity:

These modifications comprise changes in the relationships betweenPersons and Entities including the creation or deletion of relationshipsbetween Persons and Entities.

A process to modify the relationship between a Person and Entity may becomprised of the following steps:

-   -   i. Read input record into memory; if no more input exists, exit        process    -   ii. Locate Person Entity and the Target Entity for the        relationship    -   iii. Load at Target Entity's Attribute Relationship Requirements        for Roles    -   iv. If the Person Entity does not have the Attribute        Relationship Requirements, and there are defaults values for all        of the said Attribute Relationships that are lacking, then add        the Attributes to the Person Entity with the default values    -   v. If the Person Entity has all the required Attributes for the        Roles, create the relationship.    -   vi. Go to Step (i)        -   In an embodiment, if Attributes are lacking in the Entity            for completing the process of modifying a relationship            between a Person and another Entity, but however, there are            default values for all of the said necessary Attribute            Relationships that are lacking in that Entity, then these            default values are instead used to complete the modification            process.

An example of commands which may be used to do this are as follows:

<ChangeTopic TopicID=“567” Topic=“Office Visit: Severe Asthma”> <Topic.Person.Provider.Attributes Provider = “Dr. Lon Jones”>  <Topic.Provider.Attribute.FUSevereAsthma.FirstContact = “1 day”/> <Topic.Provider.Attribute.FUSevereAsthma.- AlertLimitPeakFlowPerCent=“65”/>  <Topic.Provider.Attribute.FUSevereAsthma.-Dialog1Dialog2TimeGap= “1 day”/>  </Topic.Person.Provider.Attributes ></ChangeTopic>

-   -   The above XML pseudo-code sets Dr. Lon Jones' Attributes for the        Topic named: Follow Up of an Office Visit for Severe Asthma. For        this Topic the exemplary process sets the time for the first        follow up contact with the Patient, after the office visit, to        being one day after the visit. The exemplary process further        sets an Information Alert to be triggered if the Patient's        reported peak flow is less than 65% of the normal value for that        patient, and sets the time interval between the first and second        Interview Dialogs to one day.

(e) Modify Relationship Between a Place and an Entity:

These modifications comprise changes in the relationships between Placesand other Entities including the creation or deletion of relationshipsbetween Places and other Entities.An example of such a process to modify the relationship between a Placeand another Entity may be comprised of the following steps:

-   -   i. Read input record into memory, if no more input exists, exit        process    -   ii. Locate Place Entity and the Target Entity for the        relationship;    -   iii. Load at Target, the Entity's Attribute Relationship        Requirements for Roles;    -   iv. If the Place Entity does not have the Attribute Relationship        Requirements, and there are defaults values for all of the said        Attribute Relationships that are lacking; then fill the missing        Attributes to the Place Entity with the default values;    -   v. If the Place Entity has all the required Attributes for the        Role, create the relationship.    -   vi. Go to Step (i)

In an embodiment, if Attributes are lacking in the Entity for completingthe process of modifying a relationship between a Place and anotherEntity, but however, there are default values for all of the saidnecessary Attribute Relationships that are lacking in that Entity, thenthese default values are used instead to complete the modificationprocess.

Examples of commands for carrying out such a modification between Placeand another Entity are as follows:

<ChangeApplication AppID=“667” Place= “Ely Chemistry Lab”Application=“Test Result Delivery”>   <Application.Topic>    <Application.Topic.Haptoglobin = “Not Available”/>  </Application.Topic> </ChangeApplication>The above XML pseudo-code removes the Topic Haptoglobin from theApplication “Test Result Delivery” for Ely Chemistry Lab. Anotherexample of commands for carrying out such a modification between Placeand another Entity are as follows:

  <ChangeTopic TopicID=“5643” Place= “Ely Chemistry Lab” Topic=“TestResult Delivery: Chemistry Screening Battery”>   <Topic.LDL.Range>    <Attribute.LDLMaxNormal =“100”/>   </Topic.LDL.Range>  <Topic.Potassium.Range>     <Attribute.PotassiumMaxNormal = “6.5” />  </Topic.Potassium.Range> </ChangeTopic>

-   -   The above, exemplary XML pseudo-code sets the maximum normal        value for LDL cholesterol to “100” and the maximum normal value        for a blood potassium test to “6.5” in the Chemistry Screening        Battery Test Result Delivery Topic for Ely Chemistry Lab.

In an embodiment, if the Place or Person Entity do not have theAttribute Relationship Requirements for the required Role for the Entityunder consideration and default values are not available, then therespective relationship modification between the Place or Person and theEntity is aborted and the user is informed of the missing, but neededdata.

(f) Uploading Attribute Changes to Entities:

The following process is an example of steps that may be taken forcarrying out an Uploading of Attribute Changes to respective Entities:For each record:

-   -   i. Read input record into memory; if no more input exists, exit        process    -   ii. Locate Entity, and replace and/or add Attributes for the        record-identified Entity

[2]. Pattern-Driven Interviews Instantiating Agent 432

The Pattern-Driven Interviews Instantiating Agent 432 of FIG. 4 mayfunction among other things as a Health Maintenance Interview AssigningAgent which automatically generates, Instantiated Health MaintenanceInterviews. Provided within the System Database and/or the InterviewsInstantiating Agent 432 itself there may be a set of one or more AgentInterview Instantiation Rules. An Agent Interview Instantiation Rule maybe comprised of data and/or logic defining:

i. Set(s) of Application/Person Role(s)

ii. Person Attribute(s) Qualifying Ranges

iii. Person Sex Values (Male Only, Female Only, Male or Female)

iv. Frequency Fire Criteria

-   -   a. Age of Person Qualifier Range    -   b. Calendar Date Qualifier Range

v. Last Fired Time.

vi. Next Fire Time

vii. Next Fire Time Determination Logic

viii. Interview Instantiation Rules

In one embodiment, the Pattern-Driven Interviews Instantiating Agent 432automatically and periodically loads each Agent Interview InstantiationRule into memory and if the Pattern-Driven Interviews InstantiatingAgent 432 finds that the Next Fire Time is less than the current time,and the Pattern-Driven Interviews Instantiating Agent 432 then performsthe following steps:

-   -   a. For each of the Application(s) listed in Part (i) of the        Agent Interview Instantiation Rule, create a set of Patients        where the Relationship Role exists.    -   b. From the set, remove Patients who do not have each proper        value for the Patient Attribute, including, if applicable, Sex        Attribute, that falls within each Person Attribute Qualifying        Range.    -   c. From the set, remove Patients who are not within the Age of        Person Qualifier range    -   d. From the set, remove Patients who are not within the Calendar        Date Qualifier range    -   e. For each Person in the set        -   i. Instantiate an Interview if Topic Rules allow.        -   ii. Use the Topic Rules to            -   1. Set Alerts, if any.            -   2. Set Priorities for each Interview Dialog for the                Interview            -   3. Set the Delivery Schedule for each Interview Dialog                for the Interview            -   4. Set the NeedsReview Property of the Interview to                “False.”            -   5. Create relationships with Persons to the Interview                including Primary Care Provider            -   6. Use the Interview Instantiation rules, if they exist,                to modify Interview Attributes    -   f. Use Next Fire Time Determination Logic to set the Next Fire        Time value for the Agent Interview Instantiation Rule.    -   g. Increment the Last Fired Date to now

[3]. Medical Provider and Medical Assistant Screens 401.

A Medical Service Provider or Medical Assistant who has access to theSystem screens and/or to other user-interfaces, (i.e. voice-baseduser-interfaces of the System) can perform one or more of the followingactions: 1) Instantiate an Interview with a Target Person or a TargetGroup and thereafter change the NeedsReview property of the instantiatedInterview, and 2) Upon reviewing such an Interview, change theNeedsReview property of an Interview whose NeedsReview property is“True”. Examples of screens that may be used to accomplish the above inone given embodiment are illustrated in FIGS. 10A, 11, 12, 13, 14, 15,and 16.

A process for carrying out such an instantiating and modifying of anInterview may comprise the following steps:

-   -   a) An authorized user such as a Medical Service Provider or        Medical Assistant selects the Target Person or Target Group, by        way of a Target-locating screen such as shown in FIG. 11.    -   b) The user then selects the Topic Category of the Interview        from the tab buttons (e.g., 1208, 1218, 1219, 1230, or 1211 of        the selection options shown in FIG. 12) on the user interface.        Topic Categories may include Acute Illness Monitor, Specialist        Follow Up, Test Follow Up, and/or Health Maintenance. Screens        may be provided for Custom Interviews as well and also for        reporting Test Results. (Incidentally, if a reference number is        enclosed in square brackets in an illustrated screen, that means        the reference number is not part of the screen-displayed        information.)    -   c) The user selects a Topic Group: For example, “Test Group:        Bacteriology” in 1220 in FIG. 12 or “Diagnosis: Asthma” in 1304        in FIG. 13.    -   d) Using a pop-down menu or another appropriate selection        mechanism, the user selects a particular Topic in that group,        such as in 1221 (“Strep Culture”) in FIG. 12 or in 1305        “Asthmatic Bronchitis-antibiotics” in FIG. 13.    -   e) Depending on the Topic the user sets a time value, which        helps determine when the first Interview Dialog of the Interview        is to be sent, such as shown at 1407 in FIG. 14. The user may        also choose a time to trigger a Retrieval Alert or accept a        default time, such as shown in box 1224 in FIG. 12.    -   f) The user may add additional phrases as desired, such as shown        in the X-able selection box 1222 in FIG. 12.

g) If permitted by the applicable Rules, the Interview's NeedsReview

Property may be automatically set to ‘False’ after the user presses the“Send” button, such as shown in the mouse-clickable box 1225 in FIG. 12.In such a case, the formulated Interview will be instantiated forsending without need for further review. The latter, review-free-sendingcan be contrasted with row 1017 (Action=SEND) of FIG. 10A which showshow there may still be a true NeedsReview Property in a partially, oreven fully, formulated Interview concerning *new information about testresults recently received from a laboratory indicating that the Patient(Winton) appears to have a case of Strep Throat. The Primary CareProvider (PCP) has not yet looked at the details of this,uploaded-from-LAB Interview; which is why the ACTION requested (1008) isSEND rather than REVIEW. In the example, the System or Application Rulesrequire the PCP to be first informed of this new situation even if theUpLoaded Interview (the details that will appear when “clicking-through”row 1017), even if the underlying Interview is already fully formulated;which is why the NeedsReview Property for the underlying Interview isforced to be True at least until the PCP indicates he/she has receivedthe report and approved the SEND-ing (1008) of the underlying Interview(as modified or not by the PCP) to the affected Patient and/or otherTargeted Persons.

The instantiated Interview (of FIG. 12) with NeedsReview property set to“False” is then sent from the Screens Client unit 401 via the XMLconnector 427. The XML data is transferred from XML Connector 427 to theEngine 428. The data is then transferred to Database 433.

The Database stores such user-formulated, Instantiated Interviews withtheir associated Target Person or Target Group along with their DeliverySchedules. In one embodiment, the System can only deliver Interviews totheir designated Target(s) if the NeedsReview property is equal to“False” (or an equivalent indicator). If the NeedsReview property isinstead “True”, an MSP or other responsible person is alerted to performthe required Review before the formulated Interview is permitted tobecome deliverable.

For a Test Result reporting-Interview, the NeedsReview property can bechanged to bypass the need for a Review as described herein or by theMedical Provider accessing the corresponding Interview such as in box1012 of FIG. 10A and thereafter changing the NeedsReview property. Forexample, a Medical Provider upon clicking (e.g., once-clicking,double-clicking or other wise activating by special keying or otherinput) on an abnormal laboratory result Alert noted in box 1012 (i.e.,such as the one shown in row 1017) of FIG. 10A may be presented with ascreen such as illustrated in FIG. 12. The Medical Provider may nextselect Addendum Phrases in 1222. When the Medical Provider then pressesthe “Send” button 1225, the selected Addendum Phrases 1222 referencesare added to the Interview, and the Interview NeedsReview property isautomatically set to “False” because the System deduces from the MSP'sactions that he/she has finished reviewing the Interview.

Typically, Interviews for reporting to Patients their correspondingresults when the results are within the medical and/or testingfacilities' normal range relative to the corresponding Patient'sAttributes are initially Instantiated with their NeedsReview propertyset to “False”, and are therefore able to be delivered to their Targetwithout calling for intervening Medical Provider review. The MSP isthereby relieved of having to review most of the incoming, and typicallynormal, test results and can focus his/her attention on those of thereceived test results that the System determines as showing one or moreabnormal results.

(C) Advisement Instantiation and Activation

Advisements serve to notify Patients that there are Pending Interviewsthat they should access. In an embodiment, Advisements are a specializedform of an Interview.

In an embodiment according to FIG. 4, the Advisement Sender Agent 460contains Advisement Send Rules, which are used to send Advisements. Thefollowing are examples of Advisement Send Rules:

-   -   1) If Target Person has at least one Deliverable Interview with        a Retrieval Alert and has not retrieved this Interview within an        Application Attribute set number of days before this Retrieval        Alert is to be triggered, the Target Person is sent an        Advisement of such an upcoming Retrieval deadline.    -   2) If the Target Person still has pending an amount equal or        greater than an Application-established Attribute number of        Retrieval Alerts, the Target Person is sent an Advisement about        having such an excessive number of still-pending Retrieval        Alerts.    -   3) If a user of the System activates a System function for        sending an Advisement to a Target Person, then that Target        Person is sent a corresponding Advisement.

In one embodiment, Advisements are sent to the Target at least via anemail or pager notification or the like to thereby bypass theanswering-machine problems noted above.

(D) Selection and Loading of Pending Dialogs

In one embodiment, all Interviews are stored in the Database 433. Eachsuch Interview has at least one Interview Dialog. An Interview Dialoguses logic and data from its corresponding Topic Dialog for formulatingthe Dialog content and delivery methods.

Each Topic Dialog may contain one or more of:

(1) Delivery Strategy Sets;

(2) Dialog Logic and Phrases, that:

-   -   a. Define Phrases (i.e., for example, statements, questions, and        answers in the Dialog);    -   b. Define question, statement, and answer formation and logic    -   c. Define adaptive content presentation;    -   d. Define rules for Information Alert formation; and/or    -   e. Define internal variables used for directing question or        statement delivery.

Each Interview Dialog should contain specific questions, statements, andanswer choices for provision in a correspondingly-formulated Dialog aswell as Information Alert Data and delivery attempt and historyinformation pertaining to that Dialog.

An Interview Dialog typically presents, in a single contact session, itsquestions and/or answers to the Target and collects correspondinganswers or requests from the Target during the session. Each InterviewDialog is associated with a corresponding Delivery Schedule and aDelivery Strategy.

During Instantiation of an Interview, a Dialog Delivery Schedule iscreated for each Interview Dialog. This Delivery Schedule can bespecified as a Time Period whose counting commences immediately afterthe Interview is set to the Deliverable State. The Interview Dialogdelivery time range may have one or both of an upper and lower value.These values may be used to create the Delivery Schedule of theInterview Dialog.

When an Interview is Instantiated for a given Topic, exactly oneInterview Dialog should be created for each Topic Dialog for the givenTopic. These Interview Dialogs should be ordered in precedence ofDelivery Times, with earliest being scheduled first for delivery.

Each Topic Dialog may have an InterDialog Time Gap that specifies theminimum time before a next Interview Dialog can be delivered after thegiven Interview Dialog has been delivered. The InterDialog gap serves toprevent overlapping of Interview Dialog Deliveries, and also to makesure a proper minimum time exists between Interview Dialog Deliveries asmay be appropriate. If a given Topic has only one Topic Dialog, then itdoes not need to have a corresponding InterDialog Time Gap Value. Also,in one embodiment, the last Topic Dialog in a Topic Dialog-Collectionhas no InterDialog Time Gap.

The Delivery Scheduler may use the InterDialog Time Gap in conjunctionwith the Dialog's Delivery-Schedule to determine if the Interview Dialogis currently deliverable. In an embodiment, Interview Dialog deliverytimes are made automatically responsive to Interview Dialog Responses.More specifically, in an embodiment, the delivery-attempt time toinitiate the attempted delivery of a first, new Interview Dialog isdetermined using an Attribute, such as a Person Attribute which storesthe last time the Patient came into the office for an office visit, orstores other sentinel medical events. In this way, the Interview can bedelivered on a patient-centric time schedule.

In an embodiment, the Dialog Time Gap and Delivery times for InterviewDialogs may be specified as fuzzy specifications—that is, e.g., aminimum time gap specified as one day (e.g., next day) may beinterpreted by the System as meaning the next morning at, say 8 AM,instead of strictly twenty four hours after the setting of the InterviewNeedsReview Property to “False.” This would permit, e.g., InterviewDialog delivery attempts during optimal times both for morning andevening of the following day.

In an embodiment, Dialog Time Gaps can be set as fixed periods, whichare stored in the Topic. In an embodiment, Dialog Time Gaps can be madeautomatically responsive to Patient responses of prior Dialogs in agiven Interview so that Dialog Time Gaps automatically adapt topatient-centric factors.

The Deliverable Interviews Manager 523 of FIG. 5 automatically scans theDatabase 433 for Deliverable Interviews. Deliverable Interviews aredefined in that embodiment as Interviews that have a DeliverableInterview Dialog. A Deliverable Interview Dialog is defined in thatembodiment as an Interview Dialog wherein: 1) the Interview DialogStatus equals “Pending”, 2) the Interview Dialog belongs to an Interviewwhich has an Interview NeedsReview Property set equal to “False,” and 3)the Interview Dialog to be delivered has a next delivery-attempt timewithin the Interview Dialog Delivery Schedule, taking into accountDialog Time Gaps.

The Deliverable Interviews Manager 523 orders such DeliverableInterviews by their respective Pending Interview Dialog Priority values.The Priority value of a given Deliverable Interview may be determinedautomatically as a function of the Priority value of its Application,the Dialog's Priority value, and the Target Person's Priority value. Inan embodiment different weights are assigned to each of these types ofPriority values on a Topic by Topic basis, Person by Person basis,Application by Application basis and so on.

The Deliverable Interviews Manager 523 can further and adaptively adjustthe Priority of a Deliverable Interview Dialog in a DeliverableInterview in response to Entity Attributes and the time period theInterview Dialog has been pending on the System. This method increases'the chances for Deliverable Interview Dialogs from DeliverableInterviews that may have low Priority, where such relatively lowPriority values may otherwise make it less likely that the Interviewwill be delivered in the face of competition from higher PriorityInterviews. Long-pending Interviews tend to have their Priority valueincreased before they are removed from the System due to being too old.

In an embodiment, the Interview Dialog Priority is determined by afunction responsive to the Priority of the Person that initiated theInterview. In the same or another embodiment, the Administrator maymanually set or reset the Interview Dialog Priority. In one particularembodiment, the Priority of the Target Person is weighted greater thanthe Interview Dialog Priority and the Application Priority. In anotherembodiment, the Application Priority is weighted greater than the Personand Interview Dialog Priority values. In an alternate embodiment, theInterview Dialog Priority is weighted greater than the ApplicationPriority and Person Priority.

The Deliverable Interviews Manager 523 may also be made responsible forremoving from the Deliverable Interview Dialog queue any DeliverableInterview Dialogs that have been on the System for a period of time pasta predetermined expiration time. In an embodiment, when a DeliverableInterview is removed from the System, a Deliverable Interview UnsentAlert is automatically sent to a corresponding Quality Assurance Bodyand/or a corresponding Medical Service Provider associated with theunDelivered Interview. In an embodiment, the sending or not of thisInterview Unsent Alert is made programmably responsive to the content ofthe Deliverable Interview.

Upon request and/or after a chosen time period the DeliverableInterviews Manager selects by Priority, Deliverable Interviews Dialogsand passes them to the Scheduler. The chosen time period may depend onthe System's delivery capacities and the number of DeliverableInterviews then pending in the System. This chosen time period should beselected to avoid prolonged storage of undelivered DeliverableInterviews in the System. The priority-wise, selected DeliverableInterviews and their Interview Dialogs are transferred from theDeliverable Interviews Manager 523 to the Scheduler 450 for subsequentprocessing.

(E) The Scheduler 450

A. Selecting Interviews (Interview Dialogs) to Deliver

The Scheduler 450 interacts through the Channel Manager 501 with one ormore communication Channels. The Interview Chooser 519 of the Schedulercomputes the number of Interview Dialogs that each Channel Manager canprocess over a given time period. This number of Interview Dialogs maybe determined so that the request will retrieve a suitable number ofInterview Dialogs to allow timely re-access for new Interview Dialogs byeach Channel Manager. The methods the Scheduler uses to determine thenumber of Interview Dialogs to be sent by way of each channel arediscussed below. The Interview Chooser 519 then requests the number ofInterview Dialogs from the set (ordered by Priority) of DeliverableInterviews Dialogs in Deliverable Interviews held in the DeliverableInterviews Manager 523.

(a) Selecting the Appropriate Delivery Strategy:

Each Deliverable Interview has a corresponding Target Person. For eachTarget Person the System finds a corresponding set of preferred Channelsand preferred delivery-attempt times. Then the appropriate set ofDelivery Strategies for the current Instance of each DeliverableInterviews Dialog is formulated.

Delivery Strategies may be comprised of a set of data structuresincluding those defining a Channel Type, suitable delivery times,relative Priority—i.e., the order of use of different Channels, whetheror not to abort the use of the Channel if there is a hang-up or anequivalent disconnect action, and whether or not to overridepre-specified Target restrictions on use of the given Channel.

A Delivery-Strategy selecting algorithm may be used to determine whichDelivery Strategy to use from a provided set of available InterviewDialog Delivery Strategies. This algorithm can include matching theTarget Person's Channel preferences to find suitable channel candidatesfor making delivery attempts. The Delivery-Strategy selecting algorithmmay be comprised of the following steps:

-   -   (i) Determining if the Target person has blocked this Dialog,        Topic, and/or Application. If the Topic is blocked, the status        of all Interview Dialogs for the Interview is set to blocked and        the Interview Dialog is automatically removed from the list of        Deliverable Interview Dialogs. The System stores the information        that the Interview Dialog was blocked as the reason that the        status of all these Interview Dialogs was set to Not Delivered.        In an embodiment, if the Interview Dialog is blocked, then a        Blocked Dialog Alert is sent to a corresponding Quality        Assurance Body and/or to the corresponding Medical Provider. In        an embodiment, the determination of whether or not to send a        Blocked Alert is specified in a Topic Setting.    -   (ii) Determining if the Delivery Strategy Channel has been        exhausted for this Interview Dialog—that is, have there been        more than a pre-determined maximum number of failed contact        attempts using this Channel. If the maximum allowed number of        failed contact attempts has been reached or exceeded, then this        Delivery Strategy Channel is removed from further use by the        Scheduler for the given Interview.    -   (iii) A search is made to find matches for the Target's        preferred Channels with their corresponding Delivery Time        Preferences and the Dialog's Delivery Strategies, where the        present time falls within said Delivery Time Preferences.    -   (iv) If a match is found, the System checks to see if the        Required Strategy Completions for the given Delivery Channel has        been satisfied for the Interview Dialog. If not, this Delivery        Strategy Channel is not considered further by the Scheduler for        the given Interview. For a given Delivery Strategy, the Required        Strategy Completions specify the Delivery Strategies that must        have been completed prior to the given Delivery Strategy being        considered to be used for delivering the Interview Dialog. In        one embodiment, in order for a Strategy to be considered        completed, it must have been utilized a minimum number of        attempt times for a given Interview Dialog. If a given Interview        Dialog Strategy has no Required Strategy Completions, then the        Interview Dialog Strategy can be used for delivery of the        Interview Dialog.    -   (v) The current number of attempts to deliver the Interview        Dialog should be less than the Delivery Strategy's maximum        number of allowed attempts.    -   (vi) If all the above requirements and matches are satisfied,        the Delivery Strategy is placed in a list of eligible Delivery        Strategies for this Interview Dialog. This list is ordered in        terms of Priority of eligible Delivery Strategies.

If there are no eligible strategies after the above testing, then thisalgorithm is repeated but modified to disregard the Target Person'spreferred Channel open times.

If there exists at least one eligible strategy, this is added to thelist of Delivery Strategies that can be used for this Interview Dialogcommunication attempt. Those of the selected Interview Dialogs thatbecome associated with eligible Delivery Strategies are now marked as“Chosen Interview Dialogs” in the list of prioritized Pending InterviewDialogs. For each Target, the Interview Dialog in the list of the ChosenInterview Dialogs that has the highest Priority is called the PrimaryInterview Dialog.

(b) “Packing” or Collecting Other Pending Interview Dialogs for Deliveryto a Target with a Chosen Interview Dialog

If a Target Person has several Deliverable Interviews, each containing adeliverable Interview Dialog, it is advantageous to deliver more thanone Interview Dialog in a single, successful contact. This decreasesinterruptions of the Target Person and increases the efficiency of theSystem.

In an embodiment, this is done as follows by the Scheduler 450:

-   -   (i) Collect all Target Persons associated with the chosen        Interview Dialogs.    -   (ii) “Pack” the Interview Dialogs associated with each Target        Person—that is,        -   (a) Combine all Deliverable Interview Dialogs for each            Target Person with a Primary Interview Dialog with the            limitation that each communication pack contains Interviews            only for a single Application. In an embodiment, each said            communication pack may contain Interviews for more than one            Application.        -   (b) For each of these Pending Interview Dialogs the            Scheduler verifies that the Interview Dialog delivery can            occur on the same Channel as the Primary Interview Dialog.        -   (c) For each Pending Interview Dialog the System also            verifies that the Interview Dialog delivery can occur at the            same time as the Primary Interview Dialog.        -   (d) If the above are true, then the System adds this            Interview Dialog to the list of Interview Dialog(s) to be            delivered to the Target in Priority order.    -   (iii) “Prune” this packed list of Interview Dialog(s) to be        delivered to Targets to an acceptable maximum number if the        latter number is exceeded. In different embodiments, there are        different ways for the System to compute this maximum number,        For example:        -   (a) In one embodiment, the Application specifies a maximum            number of Interview Dialogs acceptable for delivery per            Channel Type. The list of packed Interview Dialogs is then            trimmed back to this maximum number by removing from the            list, those Interview Dialogs with the lowest Priorities.        -   (b) The Channel may compute the total number of Interview            Dialogs to be delivered based on an acceptable total overall            time for delivery of a set of Interview Dialogs. In an            embodiment, the maximum allowable time is specified by the            Application per Channel Type. Each Interview Dialog            specifies a metric related to the average number of            questions that the Interview Dialog would present before            being completed. An estimated completion time for the set of            packed Interview Dialogs can then be calculated using the            average number of questions per Interview Dialog. Interview            Dialogs will be pruned off the packed list in reverse            priority order until the estimated, total conversation time            for the planned contact-pack is less than the maximum            allowed by the Application.    -   (iv) The remaining Interview Dialogs selected are then marked by        the System as scheduled Interview Dialogs and thereby removed        from the class of chosen Interview Dialogs.    -   (v) The Interview Dialogs not selected for attempted-delivery        are cleared from the delivery-processing elements of the System        so they may be considered for processing again later.    -   (vi) For each Interview Dialog selected for delivery, the System        retrieves all the corresponding Interview Dialog information,        Person identifiers, and Attributes from the Database and        completes the data requirements for generating a deliverable        communications package therefrom.    -   (vii) Each deliverable Interview Dialog is then 1) added to the        “Waiting for Response” queue of “Executable Interview Dialogs”        516 and 2) forwarded to the appropriate Channel Manager in 501        via the Connection Handler 513.    -   (viii) The Connection Handier 513 also loads the Interview        Dialog into queue block 518, namely, the Interview Data Waiting        for Response from Channel Manager.

In an embodiment, a Topic parameter may be used to selectively bypassthe process of packing other undelivered Target Interview Dialogs with achosen Interview Dialog. This packing-bypass option can be advantageousif it is desired in certain situations (e.g., a medical epidemic) forthe System to contact as many Targets as possible as fast as possible.In another embodiment an Application parameter may be used toselectively bypass the process of packing other undelivered TargetInterview Dialogs with a chosen Interview Dialog.

(c) Channel Manager 501

The Channel Manager 501 receives requests to deliver Interview Dialogsfrom the Scheduler 450. The Channel Manager retrieves the correspondingInterview Dialogs, and passes them to an Interview Dialog request queue503.

When a free port is or becomes available for an appropriate Channel, theDialog Manager takes the next Interview Dialogs Pack available fordelivery from the Interview Dialog request queue 503 and passes it (505)to the corresponding, channel-specific logic 510 for further handling.In the process, the System should check to see that the Channel requestis valid and that the to-be-transmitted Interview Dialog information iscomplete. If any of the required information is missing, the InterviewDialog should be removed from the Interview Dialogs Pack and theInterview Dialog should be rejected with a message being sent to theresponsible entity indicating what data is still missing.

If System determines that the Interview Dialogs Pack under considerationhas no (further) Interview Dialogs, then the Interview Dialogs Pack isremoved from memory. Once the delivery-supporting information iscomplete and validated for each Interview Dialog in the InterviewDialogs Pack, and the Interview Dialogs Pack has at least one InterviewDialog, the Channel Specific Logic 510 assigns the Interview DialogsPack to a port and calls the corresponding delivery actualizing routineas is indicated for the Outside Connection 511. The Interview DialogPack is then passed to a Channel Client Manager and Client such as PagerManager 406 and Pager 440 or Web Browser Manager 451 and Web Client 452for subsequent handling.

(d) Executing an Interview Dialog:

When an Interview Dialog is delivered and processed, the Systemretrieves the Attributes from the Entities associated with the Interviewneeded to process the under-delivery Interview Dialog in response to aprocessing request returned from the Dialog Manager 502.

Part of the under-delivery processing can include use of a Topic Dialog.A Topic Dialog may be comprised of a set of rules described in anappropriate programming language. These rules may be used to specify:

-   -   (i) How the Phrases used in the Interview Dialog are built and        combined with one another. Phrases may be formed from a        combination of predefined prompts and certain information        obtained dynamically from the Target and/or from other sources        during the Interview Dialog delivery process.    -   (ii) When and how to ask the questions in the delivery of the        Interview Dialog.    -   (iii) Adaptive prompting—i.e., what prompts are to be        selectively presented, removed, or modified in the Interview        Dialog in response to Attributes related to the Interview Dialog        and/or in response to data returned by the Target Person. As the        Interview Dialog progresses, it may receive various kinds of        information from user responses, and such should be stored in        the Database for later processing.

(e) Return of Results from Interaction Between the Interview Dialog andthe Target:

When the Interview Dialog Delivery Attempt terminates, whethersuccessful or not, the information derived from the attempted executionof the Interview Dialog is packed together into a response message bythe Dialog Manager 502 and passed to an Interview Dialog Response Queuein 506 for ultimate return to the Database 433. Such returnedinformation may be comprised of one or more of:

-   -   (a) The status of the Interview Dialog and other delivery        parameters—e.g., whether it completed successfully or with        errors, identification of the point of any disconnect during the        Interview Dialog, and specification of the number of        access-attempts;    -   (b) New Attribute values;    -   (c) Any Alert information generated during the Interview Dialog        delivery process;    -   (d) Whether this Interview Dialog needs to be rescheduled for        later re-execution; and    -   (e) The time and duration of the Interview Dialog.

The Channel Manager 501 picks up this response message and sends it backto the Scheduler 450 via the Channel Connection 508 when thecorresponding Channel becomes available. In the Scheduler 450, thecorresponding data for the post-execution Interview Dialog is found inthe “Waiting for Response” queue 518 and both the response and thecorresponding Interview Dialog delivery information are sent forsubsequent processing by the response handier 541.

The response handler 541 may carry out the following operations:

(i) Updates

-   -   (a) Updating of status: The result section of the Interview        Dialog's response should contain delivery-status data (i.e., if        delivery was successful or not), delivery time, whether or not        there was a hang up, whether the Channel was busy, number of        security errors, whether a person answered, and whether a        Retrieval Alert is required.    -   (b) Addition of result information to a Delivery History Record.        This information is entered into the delivery attempt record,        but is more detailed and may be used to calculate the number of        attempts, security errors, hang ups, etc. over a relevant time        period.

(c) Updating the delivery attempt record by determining and recording:

-   -   1) Whether the strategy is finished, where the latter may be        true:        -   A) if the Interview Dialog is successfully delivered        -   B) if the number of delivery attempts is greater or equal to            the specified maximum attempts to be tried (Unless this is            overridden)        -   C) if the strategy was aborted    -   2) Whether or not this strategy should be aborted due to a hang        up.    -   (d) Update the Delivery Schedule if a Retrieval Alert is        required to be set (i.e., would be required if the time        expires.)        Note that the determination of whether or not a Retrieval Alert        is to be set is handled by logic in the Topic Dialog, since such        determinations depend on the data included in the Interview        Dialog. For example, normal test results do not require        Retrieval Alerts.

(ii) Update Attributes

-   -   (a) A comparison should also be made between the “before” and        “after” values of Attributes associated with the Interview        Dialog and any modified values should be automatically updated        in the Database and any new Attributes created during the        Interview Dialog should be added to the Database with optional        time and date stamping of the changes.

(iii) Process Retrieval Alerts

-   -   (a) If the Interview Dialog was not delivered successfully, the        response handler 541 should check to see if any Retrieval Alerts        need to be set.    -   (b) A check should also be made to see if the Retrieval Deadline        Date of this Interview Dialog has been reached. If so, a check        should be automatically made with the Delivery Schedule to see        whether a Retrieval Alert is to be set for this Interview        Dialog.

(c) If a Retrieval Alert is set, the Delivery Schedule should indicatethe Person Roles for the sender and Target, and the response handler canthen use this information to build a corresponding Retrieval Alertobject and to send this information to the Database.

(iv). Process Information Alerts

-   -   Information Alert data included in the response message should        be automatically sent to the corresponding response handler.        This information can include identification of the sender and        receiver Role Persons. The response handler using the Database        can then build a corresponding Alert object for the data for        each Information Alert and can send these to the Database.

(v) If applicable, Update the Interview Dialog Status

-   -   The response handler informs the AppServer to update Interview        Dialog Status to Delivered, Not Delivered, or Expired. If        appropriate, the Interview Dialog may be rescheduled for        subsequent re-execution.

(vi) Reschedule

-   -   (i) If the Interview Dialog delivery was successful, the next        Interview Dialog in the Interview is scheduled, taking into        account the minimum required time gap between this last        Interview Dialog and the next Interview Dialog.    -   (ii) If the Interview Dialog delivery failed, the Interview        Dialog should be automatically rescheduled.    -   (iii) The System should compute the next available time for        every eligible Delivery Strategy and should use the earliest        time for the reschedule time.    -   (iv) For each Delivery Strategy, the system should obtain the        current Channel status and decide if there have been too many        attempts on this Channel by comparing the history and        calculating the number of hang ups, security errors, attempts,        and/or persons answered who were not the Patient. The system        should then compare these numbers to the maximum allowed for        each of these parameters for a relevant time period. If any of        these values have exceeded their maximum during this time        period, the Channel should be considered ineligible for further        use by the given, Interview-delivery attempt. This ineligibility        may extend for only a specified “time out period.”    -   (v) If the Channel is still eligible, calculate the next        available time for the Channel.    -   (vi) Compare this time to the soonest available time so far. If        it is sooner, then it becomes the best choice or “soonest        available time for a Channel.”    -   (vii) If there is a “soonest time”, reschedule this Interview        Dialog using the soonest time as the next available time for the        rescheduling.    -   (viii) If a good next available time is not found, the AppServer        should reschedule the Interview Dialog once it gets past the        time out period specified when the Channel exceeded the        allowable number of hang ups, security errors, attempts, or        wrong person answering previously.

(f) Selection of Interview Dialogs for Inbound Requests:

A Patient can request retrieval and execution of his or her InterviewDialogs on an inbound Channel—e.g., by calling into the System toreceive messages. This request is routed through a Channel Client suchas 420 or 452 and the associated Channel Manager such as 411 or 451respectively. In an embodiment, Email 413 and an Email Manager 407 isused for this purpose.

The Channel Manager 501 forwards the patient-originated request on tothe Channel Connection Handler 513 of the Scheduler 450. The ChannelConnection Handler 513 places this request on the Channel Request Queue517 where it is forwarded to the Channel Request Handler 520 of theDataReaper 515.

The Channel Request Handler processes these Channel requests bydetermining which Person is requesting Interview Dialogs and on whichChannel. The Channel Request Handler then issues a request to theAppServer 425 for all the Pending Interview Dialogs for this Personwhere these Interview Dialogs have a Delivery Strategy able to be usedthat supports this inbound Channel. When these Interview Dialogs arereturned they are sent to the Interview Chooser 519 with the appropriateChannel selected. The Interview Chooser then sends these InterviewDialogs to the Person as described above for outbound Interview.Dialogs, in order of priority.

The Steps for a Patient telephoning into the System to obtain his or herInterviews may be comprised of the following steps:

-   -   i. Patient Calls into a Telephone Port which is assigned to a        given Application    -   ii. Patient enters ID and pass code    -   iii. Patient has a System parameter set number of tries to        validate. If the Patient fails validation in this number of        tries, the System informs the Patient that he or she has        exceeded the allowed entry attempts and ends the call; if        validation is successful, the System proceeds to the next step.    -   iv. Channel Manager Locates Deliverable Interviews for the        Patient for this Application; if there are no Deliverable        Interviews, a prompt states: “No interviews available at this        time,” and the call is ended. If there is at least one        Deliverable Interview, then the System proceeds to the next        step.    -   v. Present Each Interview, with highest priority Interview        first.    -   vi. End Call.

In an embodiment, requests are Application specific, and the inboundchannel entrance would specify the Application. In an alternateEmbodiment, the inbound requests are not Application specific, and allor a prespecified subset of all Interview Dialogs related to thein-calling Patient would be presented.

(IV) Architecture Scalability

In an embodiment each of the components can be replicated to provide forscalable growth of the System. For instance, multiple Schedulers,Channel Managers, Application Servers, Databases and Web Servers can allbe replicated as needed for performance, scalability and reliability.

(V) Interview Delivery to Target Persons

The following examples of pseudo-code illustrate delivery of Interviewsto Target Persons in an embodiment according to this disclosure. Thebelow examples illustrate the triggering of Information and RetrievalAlerts, use of Patient Attributes to influence information delivery andmeans of delivery, use of Medical Provider and Place Attributes toinfluence information delivery and means of delivery, and the influencesof different delivery strategies in different media.

(A) Acute Illness Monitor for an office visit for asthmatic bronchitis

In an embodiment, after the Medical Provider sees a Patient with acuteasthmatic bronchitis and prescribes a treatment regimen, the MedicalProvider informs the Medical Assistant of the diagnosis and treatmentregimen and requests an Acute Illness Monitor process be initiated onthe System. The Medical Provider also informs the Medical Assistant ofthe peak flow value measured during the office visit. The MedicalAssistant enters the System and brings up the an Interview formulatingscreen such as shown in FIG. 13. The Medical Assistant chooses “Asthma”for the diagnosis in text box 1304 and selects from the various Topicsfor Interviews available for this diagnosis in text box 1305 “AsthmaticBronchitis-Antibiotic.” Patient variables needed for formulating thisInterview are automatically requested in response to these choices andthe Medical Assistant next enters the office peak flow value in text box1306 and the Patient's height in text box 1307. (If the Patient's heightAttribute is already in the System it is inserted automatically into box1307.) The default value for the time of first Patient contact for thisInterview is inserted in text box 1309; and if desired, the MedicalAssistant may edit these entries. If information regarding the Patient'sheight or office peak flow are not available at the time of Interviewformulation or if data validity checks of these fields fail, thesefields are left blank and the System's code adjusts prompts to carry outan automatically-modified follow up Interview which does not usequestions that rely on the missing data.

The illustrated Interview of FIG. 13 comprises four Dialogs. DeliveryStrategies will be discussed in detail below, but for clarity pertinentaspects will be mentioned here. By default in this Interview the firstInterview Dialog will be sent within 24 hours (1309). This deliveryinstruction will be matched against the Patient's delivery channels andpreferences, if there is no Interview Dialog or Topic or Applicationdelivery instruction for this Interview Dialog to over-ride these. If,e.g., the Dialog Delivery Strategy calls for contact only between 6 to24 hours after the office visit, and the Patient's preferences indicatea telephone or pager channel with available hours in this time range,the Interview Dialog may be delivered this way. Also the InterviewDialog will be posted on a web site available to the Patient and throughan XML interface after 6 hours. Note that retrieval of the InterviewDialog by either of these means will cancel the remaining unretrievedversions of this Interview Dialog designated for delivery by otherchannels. Thus the Interview formulation is structured to urge the useof multiple channels and to thereby overcome delivery obstacles that mayarise on any one given channel.

In an embodiment, if an Interview Dialog that is under formulation(e.g., FIG. 13) has the potential of triggering an information orRetrieval Alert, transmission of the Interview Dialog by a channel whosemessage delivery operations may not directly notify the Target of thepending message (e.g., such as an email account which must be accessedby booting up a computer as opposed to a direct telephone call whichmust be answered by the Target) is automatically accompanied bytransmission by another channel whose message delivery operations canbetter assure that the Target will actually be notified of the pendingmessage (i.e., such as leaving a flashing message on the Target's cellphone voice mail account or directly ringing the Target at his hometelephone).

(i) First Interview Dialog of Interview for Follow Up for an OfficeVisit for Acute Asthmatic Bronchitis:

Exhibit 1 (appended hereto) comprises a listing of pseudo code that isusable in an embodiment of the current disclosure for deliveringInterview Dialogs for an Acute Illness Follow Up Monitor Interview for aPatient with acute asthmatic bronchitis who was placed on antibiotics.Lines 1 through 201 of Exhibit 1 represent the first Topic Dialog ofthis Interview. (Note: due to printing vagrancies, line numbers givenhere for code lines in the appended Exhibits are merely approximaterather than precise designations of the specific code portions.)

Lines 1-3 import the class libraries, packages and base classes requiredfor the program. Line 4 declares the class for this Topic Dialog as anextension of the class DialogBase. Lines 6 through 20 define constantsused in the Topic Dialog code.

Lines 22 to 28 declare variables:

-   -   (a) Variable doctor_uses_pf1 reflects a Person Attribute for the        Medical Provider indicating if the Medical Provider uses peak        flow rule 1, defined below, to monitor Patient's home peak flow        measurements in the first Interview Dialog;    -   (b) Variable doctor_uses_pf2 reflects a Person Attribute for the        Medical Provider indicating if the Medical Provider uses peak        flow rule 2, defined below, to monitor Patient's home peak flow        measurements in the first Interview Dialog;    -   (c) Variable inOfficePF is the value of the Patient's peak flow        reading obtained in the office;    -   (d) Variable retrig is an internal counter used to track the        number of requests to ascertain if the Patient has a peak flow        value ready to enter the System;    -   (e) Variable age is the age of the Patient in years;    -   (f) Variable height is the height of the Patient in inches;    -   (g) Variable sex is the sex of the Patient.

Lines 38 to 44 assigns values to these variables from the MedicalAssistant's input, the program, and/or Attribute values stored in theSystem. Lines 50 to 80 register the Dialog's Attributes and Prompts, andRoles with the delivery scheduler program. Lines 88 to 104 present astatement greeting the Patient and then a statement saying, “This is amessage from” ‘(Medical Provider's name is communicated here)’ andretrieves a response.

The new Phrase( ) function, line 88, gets the necessary Prompt(s) in theproper format for the Channel. If it is web, this is a text format; ifit is a telephony Channel, then the Prompt(s) is a recorded voice file.In an embodiment the recorded voice file is in .vox format which is 8Khz ulaw. In an alternate embodiment, text prompts can be played overthe telephony Channel using text-to-speech. If the response indicatesthe Patient has not been reached (or, in an embodiment, can not bereadily reached by, for example, coming to the phone), the communicationends and the System records that there was no response.

Note that prior to this point other portions of the System have doneverification and identification of the Patient.

Line 111 processing depends on the value of the variable “retrig.” Thisis initialized to zero at the start of the Dialog, but is incremented inline 129. The code lines 112 to 123 presents and processes the firstquery to the Patient: “Are you feeling worse than you were when you wereseen in the office?” Line 114 defines a variable “worse” to hold thisanswer, which is stored in line 115. Lines 116 to 117 cause anInformation Alert with Alert Note “worse” to be sent to the MedicalProvider's Alert Summary Screen if the Patient answers that his, or hercondition has worsened.

Lines 118 to 120 cause an Information Alert with Alert Note “NoResponse” to be sent to the Medical Provider's Alert Summary Screen ifthere is no response from the Patient to the question. Lines 124 to 154present and process the Dialog's second question to the Patient. Line125 defines a variable ready to hold the Patient's response to thequestion presented by “PROMPT_ID_READY_PF1.” This asks the Patient: “Areyou ready to report a recent peak flow meter measurement?” If thePatient's response to this second question is not “Yes,” line 127 causeslines 128 to 154 to be executed. Line 129 increments the retrig variableby one. Lines 130 to 152 represent a switch statement dependent on thevalue of retrig. If retrig is “1”, case 1, lines 132 to 138 areexecuted. Line 135 informs the Patient that the System will call back in30 minutes. Line 136 instructs the Delivery Scheduler to call again in30 minutes. Line 137 “break” causes the execution of the code to skip toline 153 “return” and the session ends.

The System then under the influence of line 136 “callAgainMinutes(30)”calls the Patient after 30 minutes. The initial processing, introductionand greetings (lines 1 to 110) are presented again. Since retrig hasbeen incremented to “1” lines 113 to 122 are skipped.

Lines 124 to 127 again present and process a query to the Patient: “Areyou ready to report a recent peak flow meter measurement?” If thePatient does not answer “Yes,” line 127 results in incrementing theretrig variable by one (line 129) to “2” and the switch statement inline 130 causes lines 139 to 144 to be executed. The Patient's answer tothe second query is saved and the Patient is informed the System willrecall in 30 minutes. Line 144 breaks out of the switch to 153 and thesystem ends the contact.

The System then recalls the Patient after 30 minutes. The initialprocessing, introduction and greetings (lines 1 to 110) are presentedagain. Since retrig has been incremented to “2,” lines 113 to 122 areskipped.

Lines 124 to 127 again present and process a query to the Patient: “Areyou ready to report a recent peak flow meter measurement?” If thePatient does not answer “Yes,” line 127 results in incrementing theretrig variable by one (line 129) to “3” and the switch statement inline 130 causes lines 146 to 151 to be executed. Line 148 causes anInformation Alert with Alert Note “No PF1” to appear on the MedicalProvider's Alert Summary Screen. Then line 150 breaks out of the switchstatements to 153 and the system ends the contact.

In an embodiment, the System may continue with an Interview Dialog evenif the Patient inputs no peak flow value. If the Patient answerspositively to the second Interview Dialog question presented andprocessed in lines 125 to lines 126, the criterion of line 127 is notfulfilled and the code execution proceeds to the third question in lines155 to line 157. Line 156 defines a variable pf to store the value ofthe peak flow entered by the Patient in line 157.

If the current peak flow is less than the office observed peak flow andthe relevant Medical Provider Attribute indicates this rule is to beused here, line 160 causes an Information Alert to appear on the MedicalProvider's Alert Summary Screen with Alert Note “Peak Flow belowin-Office Peak FlowValue.”

Line 158 uses peak flow rule 1 in lines 176 to 181 to test if the peakflow value entered by the Patient is less than the peak flow measuredduring the office visit. If this is the case, line 160 causes anInformation Alert with Alert Note “Peak Flow below in-Office Peak Flow”to be sent to the Medical Provider's Alert Summary Screen. If this isnot the case, then next, in line 162, the Patient entered peak flow, pf,is tested against peak flow rule 2 in lines 184 to 200, if the relevantMedical Provider Attribute indicates this rule is to be used here.

Peak flow rule 2 compares the Patient entered peak flow with the normalvalue predicted using a formula depending on the Patient's sex, age, andheight as indicated in lines 187 to 195. If this comparison shows thecurrent Patient peak flow, pf, is less than 50% of the calculated-normalvalue, line 164 causes an Information Alert with Alert Note “Peak Flowless than 50% predicted Peak Flow” to be sent to the Medical Provider'sAlert Summary Screen.

In an embodiment, tables of normal values of peak flow as a function ofsex, height, and age are provided and used for reference values. Ifneither peak flow rule triggers an alert, then lines 169 to 170 areexecuted which impart a message such as: “We are pleased that you aredoing satisfactorily after your office visit and will contact you foranother follow up in two days.” and end the contact session.

If either lines 160 or 164 are executed and an Information Alertregarding a seriously low peak flow value engendered, lines 169 to 170are skipped and lines 173 and 174 are executed. These produce a messageto the Patient advising a prompt reevaluation of his or her medicalcondition, such as, “Your peak flow indicates a low value. Your statusshould be rechecked promptly. Please come to the office now or go to acurrently open urgent care center now.” An Information Alert is sent tothe Medical Provider's Alert Summary Screen with an Alert Notereflecting this, and record make of the Patient's acknowledgement ofthis message. The Interview Dialog then ends.

(ii) Second and Subsequent Dialogs:

If the first Interview Dialog does not result in an Alert, a secondInterview Dialog is sent to the Patient in accordance to the DeliverySchedule Rules for this Interview; typically this would be about 48hours after the first Interview Dialog. In an embodiment, these rulesare made adaptively responsive to information received during the firstInterview Dialog including the success or not of various contact meansin making contact with the Target.

The second Interview Dialog is roughly analogous to the first. The firstquestion, however, asks if the Patient is doing better and automaticallysends an Information Alert to the responsible MSP if the Patientindicates “No.” A current peak flow reading is requested in a wayanalogous to Interview Dialog 1 above and assessed as above.

Upon completion of the second Interview Dialog Delivery Schedule Rulesdetermine the contact time and means for sending the third InterviewDialog. Typically, this would be sent about seven days later. ThisInterview Dialog is also roughly analogous to the first InterviewDialog. The first question, however, asks if the Patient now feelsnormal. Assessment of current peak flow is again performed. In anembodiment, the current peak flow could be automatically compared withthe Patient's “normal” and actions taken on the basis of thiscomparison. The Interview Dialog typically ends with a statementregarding proper monitoring and care of asthma.

In an embodiment, a fourth Interview Dialog is automatically scheduledfor and sent one to two weeks later to recheck the Patient's status andask if the Patient has questions or desires to speak with the MedicalService Provider.

(B) First Dialog of Interview for Test Result Delivery of aComprehensive Chemical Screening Battery Test Panel

Exhibit 2 (appended hereto) comprises a listing of pseudo code in anembodiment of the current disclosure for carrying out an InterviewDialog that delivers results of a comprehensive screening chemistry testpanel to a Patient. Lines 1 through 733 represent the single. InterviewDialog of this Interview. (Note: due to printing vagrancies, linenumbers given here for code lines in the appended Exhibits are merelyapproximate rather than precise designations of the specific codeportions.)

Lines 2 and 3 import the class libraries, packages and base classesrequired for the program. Constants in the program needed for thedelivery message are next defined and assigned indexes. These mayinclude:

-   -   i. Definitions of constants used in comparing test result values        to normal values in lines 7-10,    -   ii. Constants for Patient Attributes such as age and sex (lines        13-14) that interact with the program to determine, among other        things, normal test value ranges, advisory messages to users        regarding medical situations, or, in an embodiment, differential        diagnoses to be consider in relation to certain test results,        and    -   iii. The component constants and indexes (lines 17 to 43) used        with tables formed by the program to hold and report test        results to a user.

The System first forms a table to record all component test results andassociated test Attributes; the fields of this table are named in thetest field constant names in lines 17 to 25. This table is used toformulate two types of test information delivery to the Patient:

-   -   i) A ‘verbose’ form, which, e.g., would be suitable for a visual        (e.g., web page) presentation, and    -   ii) A “terse” form, which, e.g., would be suitable for a voice        (e.g., telephony) presentation.

The various Delivery Channels used in the Delivery Strategies associatedwith this Topic contain logic that selects, for example, one of theseforms of presentation.

In other embodiments, other formulations of this table and the test dataare made into other delivery formats. The verbose form presents a tableto the Patient that is formed utilizing constants named and indexed inlines 27 to 35 and the constants in lines 42 and 43. The terse formutilizes constants named and indexed in lines 37 to 43. The headers forthe columns of the internal System table used to hold the test resultsare named in lines 50 to 58. These hold the titles of descriptiveinformation for each test and are:

-   -   i. the test name,    -   ii. the specific test result for the Patient,    -   iii. the low normal or minimum normal value for the test,    -   iv. the high normal or maximum normal value for the test,    -   v. the units for the reported test value,    -   vi. a “reference normal,” which is a comment or a reference link        to a comment for normal result information for the test in        question,    -   vii. a “reference low,” which is a comment or a reference link        to a comment for information relating to a low result for the        test,    -   viii. a “reference high,” which is a comment or a reference link        to a comment for information relating to a high result for the        test, and    -   ix. a “reference indeterminate,” which is a comment or a        reference link to a comment for information relating to an        indeterminate result for the test in question, such as “This        test could not be competed due to technical difficulties.”

Each row of this table represents a different test. Indexes are assignedto the names of the tests in lines 64 to 79; Attribute names for eachtest corresponding to each of the table's column headers aresubsequently defined as illustrated in lines 84 to 267.

Lines 272 through 278 hold a standard explanation regarding the teststhat make up the chemical test panel; this helps test interpretation inreporting the results to the Patient. The next lines hold two tables ofexplanation statements relating to abnormally high individual testresults (lines 288 to 346) and abnormally low individual test results(lines 353 to 409).

For each test (“test name”) the Patient's test results are held intestRows[TEST_INDEX_(testname)][TEST_FIELD_RESULT]. The System'sinternal table listing the Patient's test results has column headernames as noted in lines 17 to 25 and are loaded into the table in lines450 to 453. Each row of the table represents a different test in thechemistry screening panel. Each row has an entry for the Attribute FieldNames in the column headers. Thus the values of a row would correspond,in order, to the test name of that row, the Patient's test result, thelow value for the normal range of the test, the high value for thenormal range of the test, the units used for the test and a reference.These values for each test are loaded into the table by lines 456 to469.

Patient Attribute values such as age and sex are loaded in lines 471 and472 and allow for the System to compute normal ranges appropriate forthe Patient in question when these ranges are functions of suchAttributes.

To insure that the elements that are needed for Interview Dialogdelivery are present prior to initiating the delivery, these elementsare registered with the Dialog Manager. This includes: the table headers(lines 486 to 488); information needed to compute normal ranges fortests such as the Patient's age and sex (lines 492 to 493); and therequired Roles (lines 501 and 502).

Lines 514 to 515 present a statement to the Patient such as: “These arethe results of your recent Chemical Screening Panel tests.” If there isno acknowledgement of receipt by the Patient of the message, line 518records this. This information may be used to send a Retrieval Alert tothe Medical Provider. In this case line 519 ends the delivery attempt.

Lines 527 to 545 use the compare method to classify if each individualtest result is lower or higher than normal, and associate thecorresponding abnormal low or high test explanation to the result. Ifthere are abnormal results, lines 548 and 549 sets the variable“haveAbnormalTests” to “true.” Line 551 forms an instance of the code ofclass DialogTable to hold the table of test results.

Line 552 determines if the Delivery Strategy calls for a verbose datapresentation, in which case the following lines are executed: Lines 554to 561 add the header names to the columns of this table, which includethe name of the test, the Patient's test result, the low normal for thetest, the high normal for the test, how the Patient's test resultcompared to the normal range, the units of the test, and a correspondingreference phase suitable for the high, low, or normal test result. Foreach test result Lines 565 to 587 adds the corresponding data in rows tothis table and thus completes the data presentation. The referencephrase for this table is obtained with the aid of lines 630 to 647.

If the Delivery Strategy calls for a terse data presentation, this isperformed using lines 591 to 627. If all the test results are normal,the Patient is so informed by lines 595 to 596, and the session isended. If there are abnormal results, lines 593 to 594 present themessage: “All your tests were normal with the exception of the followingtests:” Lines 598 to 626 then present only the abnormal test results interse form. If, in the group of test results presented, a given test isnot normal, line 605 causes the name of the test, its result, and unitsto be presented and lines 622 to 626 append an appropriate briefexplanation for either high or low results for the abnormal test result.

Lines 658 to 731 illustrate a method to test if a test result is withinnormal range for the test when the limits of the normal range depend onthe Patient Attributes of age and sex. Arrays in lines 685 through 689and lines 695 through 699 include arrays that on a given row give, insuccession, the lower age limit, the upper age limit, the lower limit ofnormal for this age range, and the upper limit of normal for this agerange for alkaline phosphatase, the test under consideration. Lines 685to 689 apply to males and lines 695 to 699 apply to females. Lines 706through 713 select the proper table and comparison values. Lines 717 and718 find the appropriate age range and lines 720 to 726 classify thetest result value as to whether it is lower than normal, higher thannormal, or normal. If the result is not classifiable this way, line 730returns an indeterminate classification.

(C) First Dialog of Interview for Test Result Delivery for aStreptococcus Culture

Exhibit 3 (appended hereto) comprises a listing of pseudo code in anembodiment of the current disclosure that may be used for a Topic Dialogthat delivers results of a streptococcus test to a Patient. Lines 1through 96 represent the single Topic Dialog of this Interview. (Note:due to printing vagrancies, line numbers given here for code lines inthe appended Exhibits are merely approximate rather than precisedesignations of the specific code portions.) Lines 1 to 5 import theappropriate packages, classes and libraries for the program. Constantsneeded for the message delivery are next defined in lines 10 to 27;these include explanation strings in lines 14 to 24 for the variouspossible test results. Variables for the Topic Dialog are defined inlines 26 and 27 and are assigned values in lines 38 to 40. Attributesand Roles are registered for the Dialog Manager in lines 43 to 59.

Line 71 presents an introductory announcement to the Patient, which isfollowed by information of the results of the test given by lines 73 to84. One of the three possible results, “POSITIVE,” “NEGATIVE,” or“INDETERMINATE,” is assigned together with a corresponding explanationstatement. Lines 86 to 90 are activated if the Interview Dialog deliveryis not acknowledged or successful and cause the Dialog delivery tocease. In an embodiment, a Retrieval Alert may be automatically sent tothe Medical Provider in this event. This last action may be madeadaptively dependent on the result of the test. Lines 92 to 94 allowfurther information to be delivered such as a link to a web page ordocument that discusses material relevant to Streptococcus infections.

(VI) Role Relationships in Applications and Interviews

FIG. 6 illustrates some of the different logical relationships that maybe developed within the System between respective Entities, includingPersons having respective Roles and Interviews that may be formulatedunder a given Application and according to the present disclosure. AnApplication named P (601) is shown to have at least a first Topic Q(602) and a second Topic R (610). The first Topic Q is shown to havedeveloped under it at least a first Interview S (603) and a secondInterview T (608). Similarly; the second Topic R has a third Interview U(609). Person B (604) is logically related within the System toInterview S as a Patient. Person A (605) is related to Interview S as aMedical Service Provider. Person C (606′) is shown related to InterviewS as a Testing Facility Person. The same Person C (606) is shown to bealso related to Interview T as a Patient. Person D (607) is related toInterview T as a Medical Service Provider. Person C (606) is shown to belogically related within the System is related to Interview U as aTesting Facility Person. The same Person D (607′) is related toInterview U as a Medical Provider. This illustrates that a person suchas Person C may interact with more than one Interview in a Topic such asInterview S and Interview T and may interact with more than one Topic inan Application such as Topic Q and Topic R. It also illustrates that aperson may have different roles in different Interviews of the sameTopic.

FIG. 7 further illustrates how different relationships between Roles,Persons, Applications, and Interviews may develop in an embodiment ofthe present disclosure. In the illustrated example, Person E (708)interacts with an Interview A (701) as a Testing Facility Person andwith an Interview B (702) as a Patient of Application R (703). The samePerson E (708) interacts with Application S (704) as a Medical Provider.Person E (708) interacts with Interview C (707) in a Medical ProviderRole and with Interview D (706) in a Patient Role. Interview D (706) andInterview C (707) are respective Interviews of Application T (705) andApplication S (704) respectively. This illustrates that the same PersonE (708) can have different Roles in different Interviews such asInterview A (701) and Interview B (702) within the context of a sameApplication R (703) and that these Roles do not have to be the same asthe Roles of this same Person in other Applications such as ApplicationS (704) and Application T (705) where again the same Person may havedifferent Roles in different Interviews.

(VII) Login Screens

FIG. 8A illustrates a Medical Service Provider Login-Screen 800 that maybe displayed in accordance with the present disclosure. The illustratedtitle bar, 801, indicates the general function of the displayed screenwindow. A drop-down text box 802 allows the Person who is trying tolog-in to choose an appropriate Application name (e.g., Good SamaritanHospital) from those allowable on the specific System. To log-in thePerson may next enter an appropriate User log-in name in text-entry box803 and a corresponding password in text-entry-accepting box 804. Tocontinue logging-in, the Person may next activate the login button 805with a mouse click or other appropriate means. If the Person who istrying to log-in has the Role of a Patient rather than an MSP for therespective Application, the System may display a fairly-similar screento that (800) illustrated in FIG. 8A except that the title bar 801 wouldinstead state “Patient Login” or an equivalent function identifier. Ifthe logging-in Patient or Medical Service Provider is recognized pertheir log-in name (803) as having a corresponding such Role only on oneApplication in the System, then the name of that one Application willautomatically appear as an unvariable default choice in text box 802.

FIG. 8B illustrates a Medical Provider Login Screen 810 for use by aMedical Service Provider when logging into a foreign account—i.e., anaccount for which another Medical Service Provider is responsible. Thisforeign account screen 810 may be accessed from a log-in selection menu(not shown) in the System. The guest Medical Provider enters his or herlogin name in text box 812 and password in text box 813. Theidentification of the account that the guest Medical Provider desires tologin to is entered in text box 814. The Application that the guestMedical Provider desires to use may be selected in drop down text box816. The Medical Provider may then complete the log in procedure byactivating the login button 815. In an embodiment, the Login AccountName may be for identifying a specific Application and/or may be aMedical Provider's code name that allows access to all Applications ofthe Medical Provider for whom the guest Medical Provider is to cover.

FIG. 9A illustrates a Medical Assistant Login Screen 900 that may bedisplayed in accordance with the present disclosure. This screen orwindow 900 may be accessed from a menu in the System. Title bar 901indicates the title of the screen. The Medical Assistant may input thename of the desired Application in text box 902 or may select it from adrop down list. The Medical Assistant may further input his or her loginname in text box 903, the password in text box 904 and the appropriatelogin account name in text box 905. The Medical Assistant then selectsthe login button 906 to enter this information into the System and, ifthe input has been done correctly, the Medical Assistant will be deemedby the System to be logged onto the specified Application (902) andAccount (905).

In an embodiment, the System allows the Medical Assistant to log intoany of several accounts that he or she has permission to use in a singlelogin interaction. In this situation the Medical Assistant may leavetext box 905 (Login Account Name) blank when activating the login button906. This causes the screen (or window) 912 illustrated in FIG. 9B toappear. Table 908 holds the Account Names 910 for which the MedicalAssistant has been granted access permission. Column 907 holds thecorresponding date of the last Medical Assistant access to thecorresponding Account on the same row. By clicking on (or otherwiseactivating) the Account Name which is desired for access, the MedicalAssistant is entered into that Account. This allows the MedicalAssistant to access any of the Accounts for which he or she haspermission to access with a single log in procedure. Button 909, whenactivated, logs the Medical Assistant off the System.

(VII) Medical Provider, Medical Assistant, Administrator and PatientScreens

(A) Screens for Sending Interviews:

FIGS. 10A, 11, 12, 13, 14, 15, and 16 illustrate various screens thatmay be used by Medical Service Providers and/or Medical Assistants in anembodiment of this disclosure to formulate Interviews that are to berespectively transmitted (delivery-attempted) to Patients. FIG. 10Aillustrates a Medical Provider's Alert Summary Screen 1000 in oneembodiment. This screen 1000 can summarize all or a highest prioritysubset of the currently active and critical (i.e., alerted) situationsin his or her practice as they are currently known to the System and/orit can summarize action item requests regarding other items for whichthe MSP and/or his/her delegees are responsible or may wish to be keptadvised of. The active and critical situations (or action itemsrequested) may relate to corresponding test results, health maintenanceissues, specialty and ancillary facility referrals for tests orconsultations, Custom Messages to Patients, follow up for acute andchronic medical conditions, Patients who were not able to be contactedafter missing a scheduled appointment, and so forth.

In the upper main part of the illustrated screen 1000 is a first box1012 that lists alerted Interviews that have been deemed by the Systemas those most urgently calling for the Medical Service Provider'sattention. In the lower box 1049 there is a display of alertedInterviews that have been delegated by the Medical Provider to a MedicalAssistant to act on. Typically, alerted Interviews are placed in box1049 only after having been “reviewed by” and then delegated underSystem-enforced policies by the responsible Medical Provider to theMedical Assistant. In one embodiment, the MSP is empowered to see orotherwise access and modify the information of both of theprimary-responsibility alerts box 1012 and the delegated-responsibilityalerts box 1049 and to zoom into the details of any item providedtherein. On the other hand, the MA can only zoom into and/or modify (asauthorized) the details of items provided in her/hisdelegated-responsibility alerts box 1049, although the MA can still seethe summarized alert reports of the MSP's primary-responsibility alertsbox 1012. In an alternate embodiment, the MA is not allowed to even seeor otherwise access the information of the MSP's primary-responsibilityalerts box 1012; and if there are plural MA's under a given Application,the MA might be restricted to only seeing or otherwise accessingdelegated alerts that were specifically delegated to her/him.

In an embodiment, selected cases or classes of alerted Interviews can bedirectly placed in the delegated-responsibility alerts box 1049according to pre-established criteria. In an embodiment, a MedicalAssistant may access the Interviews listed in box 1012 in the same wayas a Medical Provider can, but cannot remove the alerted Interview frombox 1012. In an embodiment, a Medical Assistant may access theInterviews listed in box 1012 in the same way as a Medical Provider canand the MA can remove the alerted Interview from box 1012 and shift itinto box 1049, but cannot alter any Alert property of the Interview. Inan alternate embodiment, a Medical Assistant may be empowered to alterany or prespecified Alert properties of one or more types of Interviews.

The header bar 1001 in FIG. 10A holds a button 1002 that is highlighted(or otherwise distinguished over other header bar buttons) to indicatethe screen being viewed is the Alert Summary Screen. Button 1003, “SendInterview-Locate Patient” may be activated by the user to go to anotherscreen (FIG. 11) which may be used to identify (locate) a Patient towhom the subject Interview is to be delivered. Title section 1004indicates this is the “Medical Provider Menu” and gives the name of themedical facility and the Medical Provider that corresponds to thepassword used to enter the System. Button 1005 allows for logging offthe System and Button 1007 is for accessing System help files.Activating button 1006 takes the Medical Provider to a “Settings Screen”(e.g., FIG. 26) where System parameters may be adjusted. Button 1042allows the Medical Provider to view a screen (e.g., FIG. 25) showingprevious Interviews sent. In an embodiment, the Medical Provider canaccess Interviews sent by all Medical Providers to a given Patient inthe System.

The urgent-action-called-for box, 1012 has a title bar that indicates tothe Medical Provider that his or her immediate action is being calledfor, for the Interviews listed in each row. The table 1040 may have thefollowing columns:

(I) “action” column 1008, that lists the requested activity for theMedical Provider to do relative to the alerted Interview. This isuploaded to table 1040 from the source of the Alert with the Alert Noteand information of the Interview. Column 1008 may list a “SEND” activityas in the exemplary case of Interview 1017 indicating that the MedicalProvider is being alerted to immediately send an Interview regarding thealerted subject matter of the corresponding Interview (e.g., a positivestrep culture or a high Potassium level). Column 1008 may also list a“REVIEW” activity being called for as in the exemplary case of Interview1018. This indicates that the Medical Service Provider is being calledupon by the System to review (as soon as practical) an alerted Interviewthat has been sent and to decide on its disposition. By clicking on orotherwise activating a row within Table 1040, the provider can bring upa display showing details of the Interview in the row of interest—e.g.,by clicking on row 1017, the MSP can bring up a screen such as shown inFIG. 12 that provides further information about the exemplary strepthroat results of interest.

(II) “Topic Category” column 1009 is a column that lists the category ortype of the alerted Interview. The category or type designations may beselected from the following, nonlimiting set:

-   -   (a) TEST RESULT, such as in Interviews 1017 and 1019, which        could be an alerted test result Interview being sent to the        Medical Provider from a Testing Facility or, as in Interview        1019, an alerted Interview regarding a test result that was sent        to a Patient and was not timely retrieved;    -   (b) HEALTH MAINTENANCE, as in Interview 1018, which, e.g., could        be either a Retrieval Alert if a Patient did not timely retrieve        a periodic health maintenance Interview or an Information Alert        if information requested from the Patient during a follow up        session was outside specified limits;    -   (c) DOC OR SPECIALIST REFERRAL, as in Interview 1020, which is a        follow up Interview related to a referral to a specialist or        ancillary service. This could represent an Information Alert, if        the Patient indicated a problem in the follow up Interview, or a        Retrieval Alert.    -   (d) TEST REQUIRED, as in Interview 1021, which is a follow up        Interview related to a requested test. This could represent a        Retrieval Alert if the Patient did not retrieve the Interview or        an Information Alert if the Patient did not have the desired        test performed within a specified period;    -   (e) CUSTOM MESSAGE, as in Interview 1023, which is a customized        follow up Interview that could result in a Retrieval Alert if        the Patient did not retrieve it or, in an embodiment, an        Information Alert depending on the Patient's response;    -   (f) ACUTE ILLNESS MONITOR, as in Interview 1024, which is a        follow up Interview to monitor a Patients progress for an acute        illness. This could be a Retrieval Alert if not picked up by a        Patient or an Information Alert which was automatically produced        due to the Patient's response; and    -   (g) NO SHOW, as in Interview 1032, which is a Retrieval Alert        for an Interview sent to a Patient who failed to appear at a        scheduled appointment.

(III) ‘Topic’ column 1010 is a column which gives specific informationregarding the subject matter of the Interview, such as “Asthma” for theAcute Illness Monitor in Interview 1-024.

(IV) “Patient” column 1011 is a column which gives the name or otheridentification of the Patient who is related as such to the Interview.

(V) “Alert Notes” column 1014 is a column which gives informationregarding the situation that resulted in the Alert being raised and maybe a phrase that is pre-stored in the System and is attached to theevent that engenders the Alert; and,

(VI) “Alert Type” column 1016 is a column which indicates if a RetrievalAlert or an Information Alert is associated with the Interview.

Respective information regarding individual alerted Interviews is givenin respective rows of table 1040: Thus the information of row 1017 maybe read as representing a “TEST RESULT” Interview from a testingfacility to a Medical Provider regarding a positive strep test result.It is an Information Alert and indicates that the Medical Providershould immediately send an Interview regarding this worrisome result tothe Patient. In an embodiment, the Testing Facility automaticallyobtains a Retrieval Alert if the Medical Service Provider does notaccess this alerted information within a specified time. Row 1018represents an Information Alert for “HEALTH MAINTENANCE” for Asthmaindicating a Patient has an alarmingly low peak flow reading. TheMedical Provider is requested to review this.

Row 1020 represents an Information Alert the Medical Provider is askedto review regarding a specialist referral for a breast lump andindicates that the Patient did not keep the appointment within therequested time frame. Row 1019 represents a Retrieval Alert for theMedical Provider's review regarding lipid tests in which the totalcholesterol was 250. Row 1021 represents an Interview with a RetrievalAlert for a “REQUIRED TEST,” a mammogram. The Interview was notretrieved timely within the System's delivery parameters. Column 1008 isempty for the case of row 1021, this indicating that the MedicalProvider has previously reviewed this Alert and decided to keep it asbeing an active item in his active Alert box 1012 rather than moving itelsewhere or disposing of it. Likewise, the Interview of row 1023 is aCustom Message regarding “<Message Title>”, an input placed in theSystem when the Medical Provider composed the Custom Message, that hasgenerated a Retrieval Alert; and the Interview of row 1024 is an “ACUTEILLNESS MONITOR” for Asthma with an Information Alert engendered whenthe Patient indicated he was worsening. By appropriately selecting onthe given row of table 1040, the Medical Provider's displayed screen maybe automatically switched to another one that gives further detail aboutthat Alert as will be illustrated subsequently.

In an embodiment, the Interviews displayed in box 1012 are automaticallyordered according to prioritizing rules. For example, Interviews not yetaccessed by a Medical Provider are listed first in a shaded area;Interviews requiring the action “SEND” precede those requiring “REVIEW;”certain categories of Alerts can have display-order precedence overothers.

Table 1041 of box 1049 holds alerted Interviews that have been delegatedby the Medical Provider to a Medical Assistant to follow up on. Thetitle bar 1025 contains column headings that are typically identical tothose above in table 1040. The Action column in 1025, however, nowindicates actions requested of the Assistant by the Medical ServiceProvider when the Interview was delegated to the Assistant. This isdiscussed in more detail below.

In an embodiment the Medical Provider can choose to automatically haveall Alerts of a specific Topic or Topic Category be placed directly indelegation box 1049; thus, e.g., all Alerted Health MaintenanceInterviews could be placed directly in box 1049. In an embodiment, suchInterviews could be color coded or otherwise tagged to indicate thatthey were automatically placed in box 1049 without prior MedicalProvider review.

In an embodiment, the Medical Assistant may access alerted Interviews inbox 1012 to view these Interviews in more detail, but may not transferthem to box 1049. In another embodiment, the Medical Assistant may havethe same capabilities as a Medical Provider regarding one or moreselected Topics or Topic Categories in box 1049. These abilities may becontrolled by relationships established in the System relating to thelogin identifier used to enter the System.

For purpose of example, box 1041 is shown to hold the followingdelegated alerted Interviews: Interview 1026 which has an InformationAlert indicating the Patient who is being followed after an office visitfor asthma is doing worse. The Medical Provider has requested theMedical Assistant to have the Patient set up another office visit.Interview 1030 involves a Custom Message Interview Retrieval Alert andthe Medical Provider has requested the Assistant to send a letter to thePatient regarding this. Interview 1027 is for a Patient withgastro-intestinal bleeding that was referred to a specialist; thisPatient did not retrieve this Interview Dialog and the Medical Providerdesires that the patient be called again.

Further in box 1041, Interview 1031 has an Information Alert regarding alow peak flow value noted in a Health Maintenance follow up Interview;the Medical Provider desires that an office visit be scheduled for thePatient. Interview 1028 has a Retrieval Alert and is a follow up for arequested mammogram. It is requested that a letter be sent to thePatient regarding this. Interview 1032 is for a Retrieval Alert for aPatient that did not keep an appointment regarding his hypertension; theMedical Provider desires a letter be sent and an office visit scheduled.

While FIG. 10A shows alert summarization and reporting occurring by wayof a System screen 1000, it is within the contemplation of the presentdisclosure to report summarizations and/or details of a Medical ServiceProvider's Alerts by voice-only and/or hybrid communication means. Inone embodiment, the physician dials into the System with a conventionaltelephone, cell phone, 3G-phone or like means. The System authenticatesthe physician's right to access his account using touch-tone passwordentry and/or voice-recognition and/or other security measures as may beappropriate. The System then establishes a voice-based Interview withthe in-calling physician (or another qualified Person whom the physicianhas entrusted, e.g., his/her MA) and walks the caller through a voicebased Dialog such as the following: System: “Welcome to the AlertsSummarizing Report for Dr. Jones. Press or speak “1” to hear a summaryof the 3 alerts currently pending for Dr. Jones. Press or speak “2” tohear a summary of the 5 alerts currently pending and delegated out byDr. Jones. Press or speak “4” to access a different Menu. Press or speak“9” to hang up. Press or speak “0” to speak with the System operator.”In this example, simply by logging in by phone, the physician can learnhow many alerts are currently pending. This tersely-summarizedinformation may be enough for the MSP to understand that nothing new hashappened and the MSP may therefore simply hang up.

Suppose the MSP (or MA or other trusted Person responds by asking forthe Physician's Alerts summary, e.g., by speaking the number “one” intothe phone. The System may then walk the caller through a second voicebased Dialog such as the following: System: “Welcome to the PendingAlerts Summary for Dr. Jones. At any time, Press or speak “1” to heardetails of the summarized alert. Press or speak “2” to hear a summary ofthe next alert. Press or speak “3” to hear a summary of the previousalert. Press or speak “4” to access a different Menu. Press or speak “8”to establish a conference call with the Patient. Press or speak “9” tohang up. Press or speak “0” to speak with the System operator.” In thisexample, we assume the caller quickly says the number “one”. The Systemmay then respond as follows (using row 1017 of FIG. 10A as the basis forthis example): “The highest priority Alert is a Positive Strep ThroatCulture that just arrived for Patient Steve Winton. Antibiotic treatmentis indicated for following up on this Test Result. Press or speak “1” toSupply details for the suggested follow up. Press or speak “2” to hear asummary of the next alert. Press or speak “3” to hear a summary of theprevious alert. Press or speak “4” to access a different Menu. Press orspeak “8” to establish a conference call with the Patient. Press orspeak “9” to hang up. Press or speak “0” to speak with the Systemoperator.” If the caller says “one”, the System may then walk the callerthrough a voice based version of FIG. 12 to thereby instantiate a TestFollow up Interview for the infected Patient.

If the caller instead speaks, or touch tones the “8” key, the System mayautomatically try to establish a conference call with the affectedPatient, using the delivery strategies stored in the System foroptimizing the chances that the conference call will successfullycomplete. If the System nonetheless fails to establish the conferencecall with the MSP in timely manner, the System should inform the MSP ofthe failure and allow the MSP to choose other options. In oneembodiment, while the MSP is waiting for automatic establishment of aconference call with first Patient, the System allows the MSP to hearother summarized alert reports, and interrupts the MSP with acall-waiting signal if the requested conference call is established.Conference calls may established in a variety of ways including but notlimited to conferencing through the medical facility's main office,conferencing through the System's telephone facilities and forming aconference bridge connection through the telephone company's equipment.In each case, for security reasons, the connection to the calling-inphysician should be temporarily suspended until the call-waiting signalis given so that the MSP can securely call-in into the System at thesame time via a different channel for confidential information regardinga different, e.g. next Patient on the physician's alerts list.

While the above describes a voice-only, alerts-handling transaction withthe System. Other alerts-handling transactions may include combined useof visual and audible information via third-generation wireless devices(3G devices), via wireless Personal Digital Assistants (e.g., PDA's suchas the Palm Pilot™) and other such means. Other alerts-handlingtransactions may include use of visual-only terse communication such asthrough a data-displaying pager or non-3G cell phone. The System shouldbe made flexible so that MSP's and other care-concerned Persons caneasily and with regularity check in on the status of theirSystem-generated alerts as may be appropriate for the circumstances theMSP/other finds him or herself in (e.g., driving a car, attending aconference, etc.). While it may be preferable to have the MSP or othercare-concerned Person unilaterally dial into the System, it is alsopossible to have embodiments where, for high-priority alerts as sodefined within the System, the System actively contacts the MSP/othercare-concerned Person to initiate the alerts-handling transaction. Oneexample is where a Testing Lab has sent in an alerted Test Resultsreport and has not heard back from the doctor within a System definedtime limit. Note that due to the different kinds of communicationchannels the System can handle (e.g., both Internet email andvoice-based telephone), a unified and internally-coordinatedcommunications solution can be provided for getting the necessaryinformation to the appropriate Target by whatever communication channelis appropriate under the circumstances, and that once the Target hasbeen successfully communicated with via one communication channel, theSystem can (through its internal coordination as between channelmanagers) make sure the same Target is not annoyed with further,repeated transmissions of the same information via differentcommunication channels.

The above description of screen and voice-based presentation of Alertsummaries can be expanded to include voice and/or other biometric basedauthentication of user rights and voice-based navigation through Systeminformation and actions. For example, when a physician momentarily dropsinto his office chair during a busy, often interrupted, day, analready-on terminal of the System can automatically detect his/herpresence (e.g., by sound and/or motion detection), and if there arepressing alerts awaiting handling by the physician, the smart terminalmay query with a voice question such as, “Is that you, Dr. Miller?”. Thephysician will understand this to mean that the smart terminal has somepressing matters to inform him/her of but is awaiting authentication byway of a voice and/or otherwise-based password. The physician may simplyneed to say something like, “Yes its me, what's up Alice?” whereautomated voice-signature recognition verifies that is indeed Dr. Miller(the physician for whom pressing alerts are pending). Alternatively oradditionally, the physician may be required to scan in his/herfingerprint or retinal pattern into a System security device. Onceauthentication completes successfully, the smart terminal may providevoice-based information by saying something like, “Dr. Miller, you have3 new alerts today. Do you want me to tell you about them or showthem?”. The physician may then reply, “Yes Alice, please tell me,” or“Yes Alice, please show me,” or “No thanks Alice”. In response, thesmart terminal may respectively provide a voice-based summary as wasalready explained for the telephone example above, or display the AlertsSummary such as in the form of FIG. 10A. The smart terminal may furtherallow the physician to navigate by voice-command through differentscreen presentations and/or voice presentations, to select items withinthe presentations by voice-command, to formulate and send Interviews byvoice-command and/or to locate Patients within the System byvoice-command and retrieve information about them or launch aSystem-mediated telephone and/or other communication with the locatedPatient.

Referring briefly to FIG. 10B, a signal and action flow diagram ispresented to show how, in one embodiment, action-item summaries (e.g.,SEND 1017, REVIEW 1018) and/or other progress/notification summaries(e.g., blank ACTION in row 1023) may be generated and managed. EachApplication (e.g., Service Providing Organization, SPO for short) candefine within the System, one or more abbreviations (Alert-summarizingNotes, e.g. column 1014 in FIG. 10A, item 1094 in FIG. 10B) forrespective action-item summaries and/or other progress/notificationsummaries as may be appropriate under that Application. A nonlimitingexample of such Alert-summarizing Notes as may be defined within ageneral medicine clinic is as follows: “Strep+” (to represent a positivestrep throat culture, e.g. like in row 1017); “AsthmaWorse” (torepresent a change in a known medical condition, e.g. like in row 1024);“ChestPain” (to represent a reported symptom by a Patient); “Can'tBreathe” (to represent another reported symptom by a Patient);“AllergyWorse” (to represent another change in a medical condition thatis already known to the System to be present in the correspondingPatient); “Arrhythmia” (to represent a diagnosis reported by amedically-trained person for the corresponding Patient); “Temperature”(to represent a self-reported condition assessment by the correspondingPatient or a friend/guardian); “Coma” (to represent a serious conditionassessment provided by a friend/guardian of the corresponding Patient);“NotGotBetter” or “Progress=0” (to represent a lack of positive progresswith a medical condition that is already known to the System to bepresent in the corresponding Patient); and “Progress<0” or “GotWorse”(to represent negative progress).

Each Application (e.g., representing an SPO or an arbitrary associationof one or more persons) can establish for itself (or inherit a defaultvalue from the System for) a base, Alert priority (1082) for each kindof Alert-summarizing Note. For example, a clinic that services olderpatients may assign a base priority of 80 (on a scale of 0-99) to“ChestPain” and to “Cough” whereas a clinic that services children mayassign a base priority of 30 to “Cough”. The System may thenautomatically increase or decrease the actual priority value of a givenalert, relative to its initial base value, in response to priorityadjusting rules that take into account one or more factors such as:Action requested (1088), Patient attributes, MSP attributes, Topicattributes, and so forth (see input factors box 1066). In terms of amore specific example, assume the Alert-summarizing Note (1094) of agiven alert is “ChestPain” and the Application's base value for this 80.One of the attached, priority adjusting Rules (1072) might indicate: IFPatient attributes=ChronicAnxietyDisorder AND Age<25 AND Sex=Female,THEN multiply current value of Priority by 0.50 (in essence a 50%reduction). Another attached, priority adjusting Rule (1072) mightindicate: IF Patient attributes=ChronicHeartProblem AND Age>45 ANDSex=Male, THEN multiply current value of Priority by 1.3 (in essence anincrease). Multiple ones of such adjustment rules may come into play forany given Patient and/or the Service-Providing person (e.g., physician)to whom the Alert is being routed. Thus FIG. 10B shows separate priorityadjustment operations (1072, 1072′, etc.) for each respective recipientto whom the Alert is routed.

Priority adjustment operations (1072, 1072′, etc.) are optional and notnecessary for providing Alert Summaries such as shown in FIG. 10A Thusan alternate bypass path 1072 b is shown in FIG. 10B in dashed form.Sorting of Alerts is also optional and not necessary for providing AlertSummaries. Thus an alternate bypass path 1073 b is shown in FIG. 10B indashed form about Alert Summaries Sorting operation 1073. The optionallyprioritized, and optionally sorted Summaries are then presented to theAlerted Person (e.g., the physician) in step 1074. Screen 1000 of FIG.10A is an example of such a presentation. The above-described,voice-based presentations are other examples. The extent of what AlertSummaries are presented in a given type of Alert SummarizingPresentation (e.g., screen 1000 or voice-latter not shown) can vary andcan be based on priority thresholds, recipient preferences,communication channel limitations, and so forth. Alert Summaries may becolor-coded, associated with bell or other sounds and otherwiseembellished on to help the recipient appreciate the importance or otheraspects of different kinds of summarized notifications/alerts.

In one embodiment, next step 1075 represents the Alerted Person (e.g.,the physician) clicking-in, or otherwise zooming in details of thesummarized Alert and thereby acknowledging receipt of the underlyingdetails. It will be seen shortly that, upon zooming in, the AlertedPerson may have action options such as Delegating (1076) responsibilityfor responding to the Alert to another person (see FIG. 17, describedbelow); Deleting the Alert (1077, see also FIG. 18, described below);and/or Handling the Alerted situation themselves (1078, see also FIG.19, described below) where the latter can include the option ofnonetheless keeping the Alert Summary in the Alert-summarizingPresentations (1058, see also item 1706 of FIG. 19 as described below);or the latter can include the option of letting the System automaticallydelete the Alert Summary from the Alert-summarizing Presentations(1059). Because various response and action screens have not yet beendetailed, other aspects of FIG. 10B will be discussed further below.

FIG. 11 illustrates a screen 1100 which may be displayed according tothe disclosure to allow Medical Providers to identify and/or locatePatients. Button 1003 is highlighted (or otherwise distinguished) toindicate that the user is viewing this screen. Section 1102 may be usedto locate a Patient using the Patient's name or ID number and comprisesa first text box 1104 for receiving a name or a search query to beentered by the Medical Provider. (In the illustrated example, the userhas entered a query for names having a starting letter of J* or L* or K*or R* where star (*) is a string wild card.) Text box 1106 alternativelyallows the Patient's ID or a search query therefor to be entered. Uponentering information in 1104 and/or 1106 and activating the Find button1105 a list of names from the list of all Patients in the Systemresponsive to the inputted data appears in area 1107. If the MedicalProvider then selects an appropriate one or more names from these, acorresponding one or more Send Interview screens may be responsivelydisplayed with System-available parts of the corresponding Patientspecific information filled in it. (See for example FIG. 13 discussedbelow.)

In addition, or as an alternative to searching for Patients according toname and/or ID, various Patient Attributes such as age, weight, height,sex, chronic diseases, etc. may be used to selectively find and listPatients with corresponding attributes and/or to assign such foundPatients to Interview Groups so that corresponding Interviews may beformulated for and sent to members of the formed Groups. In oneembodiment, data-entry region 1111 has a first pull-down menu forallowing one-click selection of a first Patient/Group Attribute (suchas, Has Diabetes). Alternatively, the user may type in, or copy in theidentification of the first Patient/Group Attribute (1190) intoentry-region 1111. Similarly, data-entry region 1114 has a secondpull-down menu for allowing one-click selection of a secondPatient/Group Attribute (such as, Has Hypertension). Alternatively, theuser may type in, or copy in the identification of the secondPatient/Group Attribute (1112) into entry-region 1114. The third entryregion 1189 has a third pull-down menu for allowing one-click selectionof a logical relationship (e.g., AND, OR, BUT-NOT, EXCLUSIVE OR, etc.)that is to exist in the found group of Patients between their first andsecond Attributes (1190, 1112). If the third entry region 1189 is leftblank, the System may default to using only the first Patient/GroupAttribute (1190) as the (or part of the) search criteria. Activation ofthe Advanced Find button 1170 can bring up a more complicated, searchingtool which allows the user to script a search that uses more than justthe few search categories provided by boxes 1104, 1106, 1111, 1189and/or 1114. In one such, Advanced Find screen (not shown), pull-downmenus for available attributes and possible relationships between themare provided to aid the user in formulating a search (e.g., Find allPatients whose age>50 AND whose last major physical examination was morethan 3 years ago AND whose primary-care clinic is ABC clinic BUT-NOTincluding those who received major physical reminders within the last 2months).

When a satisfactory set of search results is obtained in area 1107 (theuser may manually pare down the list or add to it), that Group ofPatients may be assigned a Group Name by entering such a name in entryarea 1161 and then activating the Form Group button 1172. The so namedand formed Group may be called up later for other uses besides sending apersonalized, Group Interview to its individual members. The user mayalso manually select one or more members from a found group to sendcustom Interviews to.

In an embodiment, the list from which Patients are selected in responseto the query posted in box 1102 may by default be comprised of all thePatients in all the System Applications or only those Patients for whomthe Place Attribute location is the clinic at which said Patients obtainmedical care or by alternative default, only another prespecified subsetof Patients known to the System.

An alternate form of locating may be performed using the search tool ofsection 1103 (This Provider's Patients). When using Section 1103 of FIG.11 the Medical Provider may enter a date in text box 1108 or choose anappropriate date using a calendar-revealing icon 1110 to show a list ofPatients seen by him or her in list box 1109 on that date. Selecting theappropriate Patient from this list causes a Send Interview screen suchas illustrated in FIG. 14 to appear with appropriate information as isavailable in the System for that Patient.

In an embodiment, FIG. 11 may also hold a group selector from which aMedical Provider may query for and/or select a group type such as, e.g.,all Patients in his practice with diabetes and on a given medication, orall members of a specific work section. In response, the MSP will bepresented with a list of such Patients. From this list the MedicalProvider can choose to send a Custom Message to the entire group or aselected subset of the group or pick a specific Patient to whom to sendan individualized Interview. The list may also be the appointmentschedule for the Medical Provider for that or a selected other day. Inan embodiment, Medical Providers are able to form customized groups forsending Interviews to or for other uses. In an embodiment, Section 1102also provides other query formation boxes such as for example, a textbox that contains the birth date, Social Security number, or anotheridentifier for Patients.

In an embodiment, the Medical Provider selects a date in box 1108 andthe System's program generates a conforming list of Persons by using thefollowing logic (or an equivalent):

Select Persons where

-   -   1) The Person has a relationship Role of “Patient” to a given        Application, and    -   2) The Person has an Interview with: (A) the Attribute of        Primary Care Doctor equal to the Medical Provider and (B) an        appointment reminder Interview with the appointment being for        one or more selected day(s).

In an embodiment, the MSP's Patients list 1109 may be programmablyconfigured to display all Patients in the System with appointmentreminder Interviews for one or more date(s) where the Medical Providerhas the Role of the Patient's Primary Care Doctor.

In an embodiment, the MSP's Patients list 1109 may be programmablyconfigured to display all Patients with appointment reminder Interviewsfor one or more date(s) where the Medical Provider has the Role of thePatient's Primary Care Doctor and the Patients' appointments are for aspecified section of a Medical Facility, such as Surgical Clinic.

In an embodiment, the MSP's Patients list 1109 may be programmablyconfigured to display all Patients with appointment reminder Interviewsfor one or more date(s) where the Medical Provider selecting the Patienthas had the Role of Medical Provider for the Patient.

FIG. 12 illustrates a screen in an embodiment in accordance with thepresent disclosure that enables a Medical Provider to formulate a TestResult Interview for sending to a Patient. In accordance with themedical facility's standards (as stored in the System Database), normaland certain other test results may be automatically sent to the Patientthrough pre-defined protocols without Medical Provider intervention.Other tests, however, are automatically uploaded as Information Alertsoriginated by the Testing Facility and listed on the Medical ServiceProvider's Alert Summary Screen, 1000 (FIG. 10A) for Review and possiblemodification or substitution by the MSP before being forwarded on to theaffected Patient. If the Medical Provider selects the correspondingInterview in Box 1012, e.g. Interview 1017, he or she is presented witha screen such as 1200 of FIG. 12. Alternatively, the Medical Providermay learn of a test result from outside of the System—e.g., by atelephone message, and may desire to report it to the Patient throughuse of the System. In this situation, the Medical Provider enters theSystem and locates the Patient using an identifying Screen such 1100 asin FIG. 11. Upon selecting the Patient through the identifying screen,the Medical Provider may be adaptively or by default, presented eitherwith the Screen in FIG. 12 or a similar one with one of the otherfunction tabs 1208, 1218, 1219, 1230 or 1211 highlighted. (See, e.g.,also FIGS. 13, 14, 15, and 16 described below.) Upon clicking the “SendTest Result” tab 1218 in one of the alternate screens, the screen ofFIG. 12 will be presented. The Patient Details Section 1201 of theScreen in FIG. 12 comprises means for the Medical Provider to obtainfurther information regarding the Patient identified by 1202. Thisfurther information can include Communication Channels 1203, Chart Notes1204, and prior Interviews 1205 related to the Patient. Each of thesebuttons provides a preview of pertinent summary information: Thus, thePatient Personal Info box 1202 can indicate the Patient's name, sex,age; etc. Communication Channels box 1203 can similarly pre-display theaddress or telephone number at which the Patient was last successfullyreached. Chart Notes box 1204 can pre-display the number of Chart Noteson the System for the Patient and the date the last one was placed.Interviews box 1205 can pre-display the number of pending, recentlycompleted, and alerted Interviews. By clicking on the appropriate one ofthese buttons the Medical Provider may learn further details about eachof these areas as illustrated, e.g., in FIGS. 36, 37, and 38. Thusclicking on 1202 can expose a table listing Patient attributes such asmedication allergies, presence or absence of specific diseases, currentmedications, etc.

To the right of the Patient Details Section 1201, the Screen 1200 showsa set of five tabs corresponding to the types of Interviews whoseformulation and/or delivery the Medical Provider may desire to initiate:Acute Illness Monitor 1208, Send Test Result 1218, Follow UpTest/Specialist 1219, Custom Interview 1230, and Health MaintenanceSubscription 1211. If the tab appropriate to what the Medical Providerdesires to do is not highlighted, the Medical Provider may select it tobring up the needed screen.

The screen illustrated in FIG. 12 may be used to send a test result to aPatient. This Screen 1200 comprises three sections: Choose Test Groupand Topic 1250; Interview Attributes 1212; and Dialogs and CommunicationPlan 1216. The Choose Test Group and Topic section 1250 comprises a dropdown text box 1220 that can provide a list of groups of tests andanother drop down text box 1221 that can provide a list of tests for thetest group chosen in 1220. Interview Attributes 1212 can provide adisplaying of a table such as is illustrated at 1214 with a title barillustrating the name of the test and a grid showing the test resultvalue(s), and can further provide a displaying of a table such as isillustrated at 1222 of “Provider Addendum Phrases,” which are phrasesthe Medical Provider may choose to add on to the System's standardInterview for the indicated test result to the Patient. In box 1224 theMedical Provider may choose the number of days after which a RetrievalAlert is triggered. Calendar 1223 may be used in conjunction with this.If the Medical Provider accesses this screen from selecting the TestResult on FIG. 10A, fields 1220, 1221, and 1214 are automatically filledin with the appropriate information when this screen comes up and arepartly grayed out to indicate the default provision of such information.Also a default value for the Retrieval Alert may be presented in box1224. The Medical Provider, in this case, may need to only decide onwhether or not to add one or more phrases from the Addendum Phrasessection 1222 and whether to alter the default value in 1224. The MSP maythen click button 1225 to initiate the attempted delivery of theso-supplemented Interview. If the Medical Provider learns of the testresult from outside of the System, the Medical Provider may select theproper information for 1220 and 1221, which will result in theappropriate test result box 1214 appearing. The Medical Provider maythen enter the result in 1214 and add appropriate information from 1222and 1224 as above if desired. If upon the Medical Provider entering theresult in 1214, the System senses that this information is also presenton the Alert Summary Screen of FIG. 10A, a warning box such as shown at1213 appears with a message so informing the Medical Provider.Otherwise, warning box 1213 is not visible on this screen.

Dialogs and Communication Planning section 1216 holds box 1217indicating parameters regarding the Dialog and Delivery of the TestResult Interview. There is only one Interview Dialog involved in thisTest Result Delivery Interview entitled “Call Strep Result.” The ContactDay is the day the Interview delivery is initiated by the MedicalProvider and it has a Retrieval Alert set. When the Medical Providerselects button 1225 to send the Interview, the System indicates thisaction and the corresponding Interview with Action “SEND” is removedfrom table 1040. The Medical Provider may then select button 1226 tomove to a screen showing the next Alert in table 1040; if this isanother Test Result with Action “SEND,” the screen in FIG. 12 re-appearsthis time filled in with the appropriate data for the next action item.If the next action item is a message to “REVIEW,” another appropriatescreen as detailed further below appears. If instead, the MedicalProvider selects button 1207, data regarding the “Next Schedule Patient”from the List in 1109 is loaded into the fields in section 1201 and, ifinformation for this Patient is present on FIG. 10A, the appropriatescreen for “SEND” or “REVIEW” is presented with this informationentered. Alternatively, the Medical Provider may select button 1206 toreturn to the screen in FIG. 11 to locate another Patient or select 1002to return to the Alert Summary Screen, or 1042 to go to a screen thatlists previous Interviews sent. Alternatively, the Medical Provider mayselect button 1005 to log off the System.

FIG. 13 illustrates a screen 1300 which allows a Medical Provider toformulate and initiate the attempted delivery of an Acute IllnessMonitor Interview to a Patient suffering from asthmatic bronchitis. Mostof the elements of the screen 1300 which are outside of the acuteillness monitoring section 1301 have been previously described. It isseen that the Acute Illness Monitor tab 1208 has been highlighted orotherwise distinguished to indicate that an acute illness monitoringfunction has been selected. Activation of tab 1208 may be used to bringup the display structures shown in section 1301 including theillustrated Assign Interview section 1302, the Dialogs and CommunicationPlanning section 1303, and the Send button 1315 which allows one or bothof the Medical Service Provider and Medical Assistant to initiate theattempted delivery of the formulated communication.

The Assign Interview section 1302 may include a pull down text box 1304from which the Medical Assistant or Medical Provider can pick theDiagnosis relevant to the office visit. The pre-listed Diagnoses couldinclude “Cellulitis,” “Otitis Media,” “Low Back Pain,” etc. Each of thepre-listed diagnoses has associated with it several possible Topicsand/or Communication Plans for follow up. Thus the diagnosis of Asthmacould have the following Topics pre-associated with it within theSystem:

(a) Asthmatic Bronchitis-Antibiotic, (b) Asthma-Prednisone started, (c)Asthma-bronchodilator added, (d) Asthma-Steroid Inhaler started, (e)Asthma-Critical Peak Flow, (f) Asthma-mild exacerbation. The pull downtext box 1305 may list these and thereby allow the Medical ServiceProvider to quickly select a suitable follow up Communication Plan. Inone embodiment, the MSP is also given the option of typing in queriesfor System-held Diagnoses and Topics and/or of typing in specificDiagnoses and Topics directly.

The Communication Plan 1303 chosen may call for added information in itsparadigm. Some of this additional information may be stored in theSystem already as Attributes for the Patient. The selection of aparticular Communication Plan may cause the System to automaticallysearch for the associated Attribute information and fill it in. If theadditionally called-for information is not available within the System,then title bars such as 1316 “Office Peak Flow” and 1317 “Height” andcorresponding input boxes, such as 1306 and 1307 are displayed inhighlighted or other fashion for indicating to the MSP or MedicalAssistant that they should input this information manually. Box 1309shows a default time for first Patient follow up contact for the Topicselected; the Medical Provider may edit this. An invoke-able calendarfunction 1308 may be used to aid in this selection of the follow update.

The Dialogs and Communication Plan 1303 holds an outline of the Topicstructure chosen in 1305. The table 1310 has column headings thatrespectively identify their information as representing: the InterviewDialog Number 1311, the Title of the corresponding Dialog 1312, the TimeRange 1313 in which the System will try to deliver a given Dialog, andan indication 1314 of whether a Retrieval Alert is set for the givenInterview Dialog. The Time Ranges in 1313 may be made adaptivelyresponsive to the information given in box 1309 for the time of firstPatient contact via System rules. Thus, FIG. 13 indicates in the exampleof table 1310 that the Topic “Asthmatic Bronchitis-Antibiotic” specifiedin 1305 has four System-automated and sequential Dialogs: The first istitled “Worse?” and will be delivered between 1 and 2 days after theoffice visit; the second is “Better?” and will have delivery attemptsmade between the third and fourth day after the office visit; the thirdis “Well?” and is to be delivered at 8 to 10 days after the officevisit; and, the last is “Got Questions?” and is to be delivered 11 to 14days after the office visit. All these exemplary Dialogs, except thelast, have Retrieval Alerts set by the System, meaning that the MSP oranother responsible person will be alerted if the Patient fails toaffirmatively retrieve and respond to the attempted delivery of theDialog. In an embodiment, the Medical Service Provider may choose not tohave Retrieval Alerts by entering “NO” in the appropriate part of column1314. Additionally or alternatively, in one embodiment, the MSP mayclick-on or otherwise activate one of the Retrieval Alert control boxesin column 1314 to bring up a detailed dialog box that allows the MSP to,at any appropriate time, change the Retrieval Alert control state forthe correspondingly-planned Dialog (e.g., 1-4) to YES, NO or another,System-allowed state, for example: YES—but use only CATEGORY-1 AlertGenerating Rules.

FIG. 14 illustrates a Test follow-up screen 1400 that may be used in anembodiment to send a follow up Interview regarding a special testordered for the Patient. This allows the Medical Service Provider toascertain if there were any problems with the Patient actually havingthe test properly scheduled and/or it allows the Medical ServiceProvider to confirm that the Patient did actually have the test carriedout. Most of the elements of the screen 1400 outside of the InterviewTest follow-up section 1401 have been previously described. Ahighlighting or other featuring of the Follow Up Test tab 1219 in theillustrated screen indicates that the Medical Provider has selected theFollow Up Test function. An activation of the featured tab 1219 resultsin section 1401 being displayed as shown to provide a correspondingAssign Interview section 1402, a Dialogs and Communication Planningsection 1403, and a Send button 1414 for the user to use to initiate theattempted delivery of the planned communication.

The Assign Interview section 1402 provides a drop down menu box 1404 forallowing the Medical Provider to select a diagnosis with a single mouseclick or like activation. In the same or another embodiment this dropdown menu 1404 may hierarchically present two or more categories oftests under which selection of the suspect Diagnosis is set forth. Belowthe Diagnosis specifying box 1404 there is another drop down menu box1405 that provides for one-click selection of specialized tests. Thedisplayed options in box 1405 may be made adaptively responsive to theinput of or selection made in the Diagnosis box 1404. Thus, if theselected/input Diagnosis “Breast Lump” was indicated in box 1404, thedrop-down choices presented through box 1405 could be made to adaptivelyinclude “Mammogram,” “Ultra-Sound Study,” or “Fine Needle Biopsy.” TheMedical Assistant or Medical Provider may select the appropriate testfor box 1405. In one embodiment this action automatically results in adefault number of days appearing in box 1407, where the latter indicatesthe time limit for test completion by the Patient. The Medical Providercan edit this number. An invoke-able Calendar function 1406 may be usedto aid in the date selection process.

The Dialogs and Communication Planning section 1403 can generate ascheduling table such as shown at 1408 that lists the Dialogs to be usedin the selected communication plan. Column 1409 holds the InterviewDialog Number, 1410 the Interview Dialog Title, 1411 the Contact Day orday after the Interview is initiated that the System will deliver theDialog, and 1412 Alert Status which indicates whether or not a RetrievalAlert is set for the Dialog. The Contact Times displayed in column 1411may be made responsive to the input in 1407 by rules and logic containedin the System. Table 1408 holds two Dialogs for the indicated follow up:Interview Dialog 1, which is an appointment reminder call and which isto be sent at 38 days after the initiation of the Test Follow UpInterview and does not have a Retrieval Alert; and, Interview Dialog 2which is a check on completion of the Follow Up Test that is to be sentat 52 days and does have a Retrieval Alert.

Specialist referral follow up Interviews can be carried out in a mannersimilar to that of FIG. 14. A drop down menu box similar to 1404 may beused to identify the diagnosis. A drop down menu box below it may beused for listing various referral sources or specialists from which anappropriate choice can be made.

FIG. 15 illustrates a Create Interview screen 1500 which may be used bya Medical Service Provider to formulate a Custom Interview for deliveryto a given one or more Patients. Most of the elements of the screenoutside of the Custom-formulation section 1501 have been previouslydescribed. The featuring of the Custom Interview tab 1230 in the screen1500 shows that the Medical Provider has elected to formulate a CustomInterview. Activation of the Custom Interview tab 1230 produces theillustrated section 1501. This Custom-formulation section 1501 containsa Create Interview section 1510. Area 1502 allows the Medical Providerto enter a Title for the Custom Interview. Text entry area 1503 allowsthe Medical Provider to enter the custom Interview text therein. Alertnotification area 1504 may be used for entering an Alert Note, if any isto be entered. The Interview Alert Note can be used in the System, forexample, by being displayed in table 1040 column 1014 if this CustomInterview is alerted. Box 1505 allows the Medical Provider to enter anumber of days for activating a Retrieval Alert or a “0” if the MSPdesires to have no Retrieval Alert. A calendar invocation function 1506may be used to aid in choosing the Retrieval Alert time. Button 1507allows the user to initiate the delivery of the Custom-formulatedInterview. In an embodiment, text-to-speech conversion software isincluded in the System for automatically converting the text entered inarea 1503 to a voice file whose content is suitable for voice-based(e.g., telephony) delivery to the Targeted recipient by way of avoice-based communication channel.

FIG. 16 illustrates a Health Maintenance Interview formulating screen1600 which may be used by a Medical Provider for formulating a HealthMaintenance Interview and initiating delivery of it to a Patient. Mostof the elements of the screen 1600 outside of the Health MaintenanceInterview formulation section 1601 have been previously described. Thefeatured Health Maintenance Subscription Interview tab 1211 indicatesthat the Medical Service Provider has selected the Health MaintenanceSubscription Interview formulating function. Activation of tab 1211results in the displaying of the illustrated screen 1600. Interviewformulating section 1601 includes a drop down box 1602 that may be usedto identify body organs, systems and/or disease groups. Upon a selectionof one of these (whether by a one-click selection from a pop-down menu,or a typed-in choice) related medical conditions and parameters suitablefor determining follow up are typically presented automatically by theSystem in box 1603 as is shown for example by the cardiovascularparameters illustrated in FIG. 16. More generally speaking, thepertinent Patient's Attributes held in the System and which areappropriate for use in determining the Health Maintenance Follow Upparadigm to be used for the instant Patient can be made to automaticallyappear in pre-checked and/or checkable form as is shown in box 1603.Thus the exemplary box 1603 illustrates the Topics and parameters thatmay be used for formulating a Health Maintenance Interview paradigmrelating to the indicated Cardiovascular system (1614) and Respiratorysystem (1610). The Medical Service Provider can select or deselect thoseconditions or descriptors in box 1603 that the MSP believes tocorrespond to the particular Patient's medical state by modifying thedisplayed Patient's Attributes. The System's logic may use theMSP-provided information to automatically select an appropriate, HealthMaintenance follow up Interview Plan for the Patient. The System haspre-defined sets of Dialogs customized to many of the conditions ordescriptors that the MSP might select and these can be built upon as maybe appropriate for the practice over time. Note that the follow upInterview Plan can be adaptively individualized in an automatic way forthe specific Patient using the Patient Attributes including priordiagnoses, current status and medical history and the System's logic.Thus, for example, a hypertensive follow up plan for the HealthMaintenance of a Patient with diabetes might include the automaticdisplaying of an alert to the Medical Provider at a diastolic pressuresgreater than 80 had been observed. On the other hand for a Patientwithout diabetes only if this measurement was greater than 90 would asimilar alert be automatically displayed to the Medical Provider. Thusautomatic alerting may be made adaptive to the Attributes of specificPatients.

The illustrated drop down box 1604 allows the Patient's primary carephysician to be identified with one click from a list ofclinic-recognized Medical Service Providers. Alternatively, it may betyped in or copied into data-entry box 1604 from other sources. Theprimary care physician (PCP) identified in box 1604 is typically the onewhom the System automatically advises of when test results have beenobtained from Testing Facilities and is typically the one to whom theSystem automatically sends Alerts for this Patient and the PCP is alsotypically the one who is made primarily responsible by the System forcommunicating with and following up with the Patient. In an embodiment,any Medical Service Provider who is using the Health MaintenanceInterview formulating screen 1600 is given permission to view allsystems and conditions that may apply to a Patient by selecting ormaking a choice via box 1602. In an alternate embodiment, the System(s)specifying box 1602 may be made adaptively limited to certainspecialties which the System associates with the Medical ServiceProvider who is using the Health Maintenance Interview formulatingscreen 1600.

In an embodiment, the Health Maintenance Interview formulating screen1600 may be used for simultaneously formulating Interviews for a Groupof Patients. For example, the Medical Provider may specify as part ofthe identifying criteria for formulating a Group Interview for pluralPatients that such Patients be all over 50 years old with Emphysemawhere the Database shows that they have not had a pneumococcusvaccination. These criteria can be established for example by using oneor more of the Group-forming resources of box 1102 in FIG. 11 and suchor other resources can be used to search the Database of the System andto thereby define a Group that satisfies the established criteria.Delivery of the so-formulated Group Interview can then be simultaneouslyinitiated for each member of this group.

In an embodiment, Edit Button 1608 provides the Medical Provider with ameans of editing a Patient's Attributes as listed in box 1603. UpdateButton 1609 allows indicated changes (indicated by highlighting orotherwise) to be recorded in the System's Database.

In an embodiment, the System allows for delegation to Medical Assistantsof the routine sending of Acute Illness Monitor Interviews, RequiredTest Interviews, Required Specialty Referral Interviews, No Show FollowUp Interviews, and Health Maintenance Interviews in response todirections passed through the System from the Medical Provider. Withsuch delegation for the handling of routine matters, the Medical ServiceProvider would have his or her attention focused mainly on: (1)formulating and sending Alerted Test Result Interviews (in response todata uploaded into box 1012 of FIG. 10A by a given Testing Facility);(2) formulating and sending Custom Messages such as shown in FIG. 15,and (3) Reviewing Alerted Interviews such as those that will now bedescribed with reference to FIG. 17—etc.

(B) Screens For Reviewing Interviews

Screens for reviewing Interviews may be typically accessed by selectingin the Alert Summary Screen 1000 illustrated in FIG. 10A the Interviewto be reviewed. Interviews may also be reviewed by selecting theInterview of interest from a list of Sent Interviews (1042) provided bythe System.

FIG. 17 illustrates, for one embodiment, a corresponding screen 1700which may be used to review a Retrieval Alert. In the illustratedexample, the Patient has apparently failed to retrieve and/or respond toan initially sent Interview warning of a positive Streptococcus throatculture result. The illustrated, Review: Test Retrieval Alert screen1700 may be presented when the Medical Service Provider selects acorresponding summary row in table 1040 in FIG. 10A (See for example row1019). Most of the elements of the illustrated Test Retrieval Alertscreen 1700, particularly in the header bar and on the left hand portionof the screen (1201) have already been described above and thus do notneed to be detailed again.

Button 1701 is highlighted to indicate that the current screen 1700 isfor Review of an Alert. Section 1702 illustrates a method for summarilyproviding the pertinent Information for Medical Provider Review. Thismay include specific information such as identifying the purpose of theboxed, summary Information in field 1705, providing a summary in boxedarea 1703 of the Interview that had been sent but apparently notretrieved, and/or such as displayed in boxed area 1720 any associatedMedical Provider prompts—such as the Addendum phrases chosen in box 1222of FIG. 12. The Delivery Record set forth in the example of box 1704indicates that the current Interview which is under review was not“completed” because for example it was not retrieved within the timelimits of the Retrieval Alert. Table 1714 summaries the Interview andindicates the Test was Strep and had a value Positive and that thenormal value is Negative. Section 1704 displays a Delivery Record forthe Interview under review. This can be done by means of a messagetracking table such as shown at 1721, which gives further informationregarding the Interview. This arrayed information may include theInterview Category, which in the example is Test Delivery, the InterviewTopic, which in the example is Strep. Culture, the date the Interviewwas sent, and the date the Interview was completed, which in the exampleis blank since the Patient did not retrieve it. Below this is aCommunication History summarizing section 1722 which can provide thecommunication history for this Interview in an arrayed format such asshown in table 1723. This table furnishes information regarding theDialog(s) in the Interview. It indicates that there was only oneInterview Dialog entitled PosStrep and that its Status is ‘NotDelivered’ since it has not been retrieved and that it has a RetrievalAlert that has been activated.

Update and Disposition section 1711 illustrates a means for updating thestatus of the Interview and its further disposition. Illustrated arethree fields and their corresponding check boxes: The Keep-on-Alertsection 1712 with checkbox 1706 indicates, if checked, that theInterview and Alert will be kept on the Alert Summary Screen. TheDelete-Alert section 1709 with checkbox 1707 indicates, if checked, theAlert is to be deleted from the System's menus. The Delegate to MAsection 1716 with checkbox 1708 may be used for delegating the alertedInterview to a Medical Assistant. A pull-down menu section withinsection 1716 may be used to select one of various delegation phrases fordisplay in the main delegation area of section 1716.

If checkbox 1707 is checked, indicating the Alert is to be deleted anaudit-trail creating, drop down box such as the one (1814) shown in FIG.18 appears indicating phrases relating to the disposition of the to-bedeleted Alert. As a consequence of such delete-and-audit actions, theAlert is automatically removed from its corresponding row in table 1040of FIG. 10A. In an embodiment, there is logic that automatically routesdeleted Alerts for further review by a Quality Assurance Body inaccordance with the medical facility's quality assurance standards andthe indicated disposition of the Alert.

If in FIG. 17, the Delegate-to MA checkbox 1708 is checked, a table suchas shown at 1717 appears listing actions the Medical Provider can checkto indicate what the Medical Assistant should do regarding the delegatedhandling of the Alert. Thus in the example of FIG. 17 the MedicalService Provider has requested through appropriate checkings that theAlert be handled by the Medical Assistant and that the Medical Assistantcontact the Patient, inform the Patient of the results, and have thePatient set up an office visit. By checking box 1708 the Medical ServiceProvider causes the System to responsively move the Alerted Interviewfrom the primary responsibility table 1040 to the delegatedresponsibility table 1041. Through the illustrated checking of FIG. 17,the MSP further causes the System to responsively set for thecorresponding row (not shown) and in the Action column of the Alert intable 1041 the corresponding Action codes “Recall” and “OV” (not shownexplicitly, but see row 1032). When delegating an Alert to a MedicalAssistant, the MSP may be provided with the option of altering thepriority of the delegated Alert so that it will be displayed higher orlower on the MA's prioritized list of delegated Alerts. In oneembodiment, the initial, System-calculated priority (1799) for thedelegated Alert is displayed in editable region 1798. The priority valuecan be a positive integer on a scale of, for example, 1-100. So in theillustrated example, the System has initially calculated the priority tobe 85 for this particular Alert item (Strep Throat Positive 1714).However, the MSP may supercede this initial value by entering a higheror lower value (or otherwise changing the initial value). The changetakes place in response to the MSP activating the Update Button 1718 asexplained below. In one embodiment, the System maintains separatepriority ratings for a same Alert respectively for the MSP and his/herMA and these, machine-calculated original values, can be independentlychanged by the MSP if he/she desires to do so and is allowed to byApplication policies. In such a case, the illustrated single box-label1799 (“Priority”) and single, data display/overwrite region 1798 may bereplaced by a plurality of such priority display and/or edit mechanisms;e.g., one box label that says “Dr.'s Priority” and has an accompanyingfirst data display/overwrite region such as 1798, and a second box labelthat says “RN's Priority” and has an accompanying, second datadisplay/overwrite region.

The Update Button 1718 allows updating of the System Database relativeto the newly inputted information. The illustrated Next-Alert Button1719 allows the Medical Provider to proceed directly to a screenappropriate for reviewing the next Alert in table 1040.

FIG. 18 illustrates for one embodiment a Follow up Review screen 1800which may be used to review a Retrieval Alert of an Interview forfollowing up a sore throat office visit. This screen is presented whenthe Medical Provider selects a corresponding summary row in table 1040in FIG. 10A. Most of the elements of the screen in the header bar and onthe left hand portion (1201) have been described above. Elements 1701,1719, 1711, 1706, 1707, 1708, 1712, 1709, 1716, 1798, 1799 and 1718 havealso been described above.

Section 1801 holds information for the Medical Provider to reviewregarding the Alert. The Alert Note gives the basis for the Alert in thehighlighted region 1808. The diagnosis applicable to the Interview islisted in box 1804 and the Topic is listed in box 1805. The MedicalProvider or the Testing Facility may have previously placed thisinformation in the System Database. (See, e.g., FIG. 13.) MedicalProvider View Prompts are presented in 1806; this area holds informationfor the Medical Provider generated on the basis of the test results. Inan embodiment, typical entries here could hold differential diagnosesfor abnormal results on a comprehensive screening battery or suggestionsfor further tests based on the results found. This information may beformulated on the basis of the test results found for the Patient. In anembodiment, these results may be used in conjunction with PatientAttributes that are recorded in the System Database to further aid inthe diagnosis and treatment of the Patient.

Section 1802 holds information regarding the Delivery Record of theInterview, which is presented in table 1807. This indicates that theInterview Category is “FU-OV” or “Follow Up for Office Visit,” theInterview Topic is “Sore Throat-Antibiotic,” the Date Sent is “Jan. 1,2000,” and that the Completed Date is blank.

Section 1803 holds information relating to the Communication History ofthe Interview. This is detailed in table 1809. Table 1809 shows each ofthe Dialogs of the Interview and has columns that show the DialogNumber, Dialog Title, Contact Date, and Alert Status. This last columnindicates if the Dialog had an Alert and the type, Retrieval orInformation. Thus Interview Dialog-1 entitled “Worse?” was retrieved on3 January and engendered no Alert; Interview Dialog-2, “Better?” wasretrieved on 4 January and resulted in no Alert, but Interview Dialog-3,“Well?,” which was sent on 9 January resulted in a Retrieval Alert.There is no contact information for Interview Dialog-4, “GotQuestions?,”since no attempt has yet been made by the System to deliver it.

In the Update and Disposition section 1711, the Medical Provider haschecked box 1707 indicating a desire to delete this Alert. This resultsin a drop down box 1814 being presented from which the phrase“Contacted, Situation Handled” as shown in 1815 has been selected toindicate how the Alert was taken care of. These actions result in thisAlert being removed from table 1040 in FIG. 10A. These actions arelogged by the System into an audit-trail log.

In an embodiment, deleted alerts are automatically routed for review bya quality assurance organization. The specific routing of suchinformation for quality assurance review can be made adaptivelyresponsive to the Alert Deletion Phrase used or the Alert Note or theAlert Type.

FIG. 19 illustrates for one embodiment, a Retrieval Alert screen 1900for reviewing a Retrieval Alert that automatically issued in response tountimely completion of a Custom Interview. This screen 1900 is presentedwhen the Medical Provider selects a corresponding summary row in table1040 in FIG. 10A. Most of the elements of the screen in the header barand on the left hand portion (1201) have been described above. Elements1701, 1719, 1711, 1706, 1707, 1708, 1712, 1709, 1716, 1798, 1799 and1718 have also been described above.

Section 1901 holds information for the Medical Provider to reviewregarding the Alert. The highlighted region 1909 indicates this is aRetrieval Alert for a Custom Message. Section 1902 holds informationregarding the Custom Message Box 1903 holds the title of the Interviewand Box 1906 holds the text of the message. This information was placedinto the System's Database when the Medical Provider created theInterview, e.g., in FIG. 15. If there are any, Medical ServiceProvider-generated, View Prompts are illustrated in area 1910. Section1904 shows the Delivery Record of the Interview in table 1905. Thisindicates the Interview Category is “Custom Message,” the InterviewTopic is “Follow Up Chest Pain,” the Date Sent is “Jan. 1, 2000,” andthat the completion date is blank. Section 1907 gives the CommunicationHistory of the Interview in table 1908. This indicates that there isonly one Interview Dialog with title “Chest Pain” and Status “NotDelivered;” this Interview Dialog has had a Retrieval Alert triggered.The Update and Disposition section 1711 indicates that the MedicalService Provider has checked box 1706 to keep this Alert in table 1040of FIG. 10A.

FIG. 20 illustrates for one embodiment, a Test Follow Up screen 2000which may be used to review a Retrieval Alert for a Required Test FollowUp. This screen is presented when the Medical Provider selects thecorresponding summary row in table 1040 in FIG. 10A. Most of theelements of the screen in the header bar and on the left hand portion(1201) have been described above. Elements 1701, 1719, 1711, 1706, 1707,1708, 1712, 1709, 1716, 1717, 1798, 1799 and 1718 have also beendescribed above.

Section 2010 holds Alert information for the Medical Provider to review.The highlighted region 2021 indicates this is a Retrieval Alert for arequired test and that there was no contact with the Patient after 52days from the time attempted delivery of the Interview was initiated.Section 2011 holds information regarding the Interview: The Diagnosis is2012 “Breast Lump;” the Test ordered is “Mammogram” 2013, and theMedical Provider felt the test needed to be done within 45 days from thetime the Interview was initiated as is indicated in the Must-Do-by box2020. Section 2019 displays the Medical Provider View Prompts, if any.

Section 2014 has Delivery Record information in table 2018. Thisindicates the Interview Category is “Required Test,” the Interview Topicis “Mammogram,” the Date Sent, “Jan. 1, 2000,” and that the CompletionDate is blank.

Section 2015 illustrates the Communication History in Table 2017. Thecolumns in this table show the Dialog Number, the Dialog Title, ContactDate, Dialog Status, and the Alert Status. There are two Dialogs:Interview Dialog-1 is a Reminder Interview that was delivered on 8February and had no Alert. Interview Dialog-2 is a check that theappointment for the mammogram was kept and was attempted to be deliveredon 1 March; it has a Retrieval Alert triggered for it, meaning the MSP'soffice has not been able to verify that the scheduled test was carriedout.

The Update and Disposition section 1711 indicates the Medical Providerhas checked box 1708. This last action caused table 1717 to bepresented, and the Medical Provider checked box 2030 instructing theMedical Assistant to send a certified letter regarding the need for thistest.

FIG. 21 illustrates for one embodiment, an Information Alert screen 2100which may be used to review an Information Alert for a HealthMaintenance Follow Up. This screen is presented when the MedicalProvider selects the corresponding summary row in table 1040 in FIG. 10AMost of the elements of the screen in the header bar and on the lefthand portion (1201) have been described above. Elements 1701, 1719,1711, 1706, 1707, 1708, 1712, 1709, 1716, 1717, 1798, 1799 and 1718 havealso been described above.

Section 2110 holds information for the Medical Provider to reviewregarding the Alert. The highlighted region 2130 indicates this is anAlert for a Health Maintenance Follow Up and that a low value for PeakFlow has been obtained from the Patient. Section 2111 holds informationregarding the health status of the Patient relative to the HealthMaintenance Follow Up Interview scheme. This data is retrieved fromPatient Attributes stored in the System that determined this HealthMaintenance Follow up paradigm. Here it is noted that the Patient hasemphysema, asthma, and seasonal allergies and in 2116 that her baselinepeak flow is 375 and in 2114 that the reported peak flow that lead tothe alert is 150. Section 2113 shows any Medical Provider view prompts.

Section 2117 indicates the Delivery Status of the Interview in table2131. This shows that the Interview Category is “Health Maintenance,”the Interview Topic is “Periodic Follow Up,” the Date the InterviewDialog was sent was “Jan. 1, 2000,” and the Date the Interview Dialogwas completed was “Jan. 2, 2000.” Section 2118 illustrates theCommunication History of the Interview in table 2119. This tableindicates that there was only one Interview Dialog with title“COPD-RAD,” (an abbreviation for Chronic Obstructive Pulmonary Diseaseand Reactive Airway Disease), and that the delivery status is“delivered” and that the Communication has resulted in an InformationAlert, meaning that during the delivered Interview, the Systemautomatically determined that information provided by the Patient neededalerted attention by the Medical Service Provider and that the Systemtherefore automatically generated a corresponding Alert which was postedto the MSP's alerts table (see for example row 1018 of FIG. 10A).

Section 1711 of FIG. 21 indicates that the Medical Provider has checkedbox 1708 causing table 1717 to be presented. The Medical Provider hasindicated a desire to have the Medical Assistant set up an office visitfor the Patient by the check-off indicator activated in box 2115.

FIG. 22 illustrates another Follow up Review screen 2200 which may beused in an embodiment to review an Information Alert that wasautomatically generated by the System during an Interview for followingup an acute asthmatic bronchitis office visit. This screen is presentedwhen the Medical Provider selects the corresponding summary row in table1040 in FIG. 10A. Most of the elements of the screen in the header barand on the left hand portion (1201) have been described above. Elements1701, 1719, 1711, 1706, 1707, 1708, 1712, 1709, 1716, 1798, 1799 and1718 have also been described above.

Section 2210 holds information for the Medical Provider to reviewregarding the Alert. Several Alerts have been triggered by this exampleof an alert-generating and under-review Interview. The System canpresent one or more of the corresponding Alert Notes in the highlightedregion 2216. The diagnosis applicable to the Interview, “AsthmaticBronchitis,” is listed in box 2211 and the Topic, “AcuteAsthma-Antibiotic,” is listed in box 2212. The Medical Provider or theMedical Assistant may have previously placed this information in theSystem Database. Also shown in box 2217 is the Peak Flow value observedduring the office visit. Medical Provider View Prompts, if any, aregiven in box 2213.

Section 2214 holds information regarding the Delivery Record in table2218. This shows that the Interview Category is “Follow Up OfficeVisit,” the Interview Topic is “Asthma-Antibiotic,” the Date Sent was“Jan. 1, 2000” and that there is no completion date.

Section 2215 illustrates the Communication History of the Interview intable 2219. The column headings of this table are: Dialog Number, Title(of Dialog or Question in the Dialog), Contact Date, and Alert. Fourentries are shown in the table. The first is for the question ofInterview Dialog-1 entitled “Worse?” The Contact Date was “3 January”and the Patient's response resulted in an Information Alert. The secondentry is for the Peak Flow reading requested in Interview Dialog-1 ofthe Interview; the Contact Date is again “3 January.” The value inputtedinto the System is 110 and this resulted in the automatic generation ofyet another Information Alert since the reported value is significantlylow and below 50% of normal for the Patient. The third entry is for theacknowledgment to the next Interview Dialog phrase requesting thePatient go immediately to the office or an emergency room. The ContactDate is again “3 January.” No response was obtained from the Patient toacknowledge receipt of this instruction, so this is also automaticallyalerted. The next entry row in table 2219 is the first question of thesecond Dialog, “Better?” and the table indicates that this message wasnot delivered. The Medical Provider has made an entry in box 1708 insection 1711 of FIG. 22. This instructs the Medical Assistant to arrangean office visit for the Patient and moves the Alerted Interview to table1041 in FIG. 10A.

FIG. 23 illustrates another Test Result Retrieval Alert screen 2300which may be used in an embodiment of the current disclosure to review aTest Result Retrieval Alert for an Interview delivering lipid testresults to a Patient. This screen is presented when the Medical Providerselects the corresponding summary row in table 1040 in FIG. 10A. Most ofthe elements of the screen (2300) in the header bar and on the left handportion (1201) have been described above. Elements 1701, 1719, 1711,1706, 1707, 1708, 1712, 1709, 1716, 1798, 1799 and 1718 have also beendescribed above.

Section 2301 holds information for the Medical Provider to reviewregarding the Alert. The highlighted area 2303 indicates the basis forthe Alert from the Alert Note. Here it is indicated that this is aRetrieval Alert for a Test Result that showed elevated lipids. Section2302 holds table 2304 that contains the name of the test, the valuesobserved, and the normal range for the values. Cell 2305 is highlighted(e.g., by double asterisks) and indicates an abnormally high value forthe Patient's Total Cholesterol; cell 2306 is highlighted differentlyand indicates a lower than normal HDL level, which is of relatively lessconcern. In an embodiment, displayed or other (e.g., voice-based)presentations of test results can be made adaptively responsive to rulesdefined within the System and some of these presentations may bevisually and/or otherwise (e.g., auditory alarm bell sound) accentuatedautomatically to reflect the seriousness of the result.

Area 2307 holds Medical Provider View Prompts, if any. Section 2308illustrates delivery information for the Interview in Table 2310. Thisshows the Interview Category is “Test Delivery,” the Interview Topic is“Lipids,” the Date Sent was “Jan. 1, 2000,” and that the completion dateis blank. Section 2309 holds information on the Communication History ofthe Interview in Table 2311. This table indicates that there is only oneInterview Dialog with title “Lipids-High” and Status “Not Delivered.”This Interview Dialog has had a Retrieval Alert triggered as indicatedin the highlighted cell 2311.

The Medical Provider has indicated in FIG. 23 at section 1711 bychecking box 1708 that this Retrieval Alert is to be delegated to theMedical Assistant. The Medical Provider has checked boxes in the table1717 instructing the Medical Assistant to inform the Patient of the testresults and have the Patient set up an office visit.

FIG. 24 illustrates a Delegation screen 24 b 0 which may be used forallowing a Medical Assistant to respond to a test Retrieval Alert inaccordance with instructions sent via the System from a Medical ServiceProvider. The illustrated screen 2400 concerns a Retrieval Alert thatwas raised by the System because of an Interview delivery failure for alipid test that showed elevated cholesterol levels. This screen 2400 ispresented to the Medical Assistant when that MA selects thecorresponding summary row in table 1041 in FIG. 10A. Most of theelements of the screen (2400) outside of the Update and Dispositionsection 2401 and Next Alert button 2419 have been described above andthus do not need to be detailed again.

In the Delegated Disposition section 2402 there is an indication of thedate the handling of this Alert was delegated to the Medical Assistant.The Requested Action area 2403 holds table 2404 that indicates theactions the Medical Provider requested be done for this alert, namely inthis example, for the MA to inform the Patient of the result and set upan office visit for the Patient. Section 2405, entitled Dispositionholds a table 2406 which provides a mechanism by way of which theMedical Assistant can indicate to the System whether and which of therequested actions were completed. In this case the Patient was contactedand informed of the results and an office visit was scheduled. BelowDisposition section 2405 there are provided check boxes 2408 and 2409where the Medical Assistant may choose to keep this Alert in table 1041(2407) or delete it from table 1041 (2409). If the latter action ischosen as indicated in 2409 a drop down box may be accessed to providean audit trail for the disposition of the Alert as is indicated forexample in area 2411. Button 2412 allows for the information added onthis screen to be recorded and the System's Database updated.

In one embodiment, Medical Assistants are blocked from being able todelete an altered (handled) Interview Alert without a Medical Provider'sreview of the handling of the Interview. Activating button 2419 bringsup on the display of FIG. 24 information for the next Alert in table1041.

FIG. 25 illustrates a Sent Interviews Finding screen 2500 which may beused to identify and/or locate sent Interviews within an embodiment ofthe current disclosure. The illustrated screen 2500 is one that MedicalService Providers may view upon selecting button 1042 of any of FIGS.10A-24. The area of mouse-activatable button 1042 is highlighted in FIG.25 to indicate that this screen has been selected. The InterviewsFinding screen 2500 comprises a search criteria section 2501 which maybe used for defining the search criteria to be used for automaticallylocating sent Interviews of the System. The Interviews Finding screen2500 may further comprise a search-results table 2514 that shows theSent Interviews that have been found by the System to fulfill thecriteria established in section 2501.

In one embodiment, the search criteria section 2501 contains a first rowof temporal option choices 2502 which allow a Medical Provider to eithersearch for Interviews sent today, last week, last month or at any time(“All”). The latter choice is, of course limited to the time period forwhich sent Interviews are kept on the System Database. The second rowprovides another temporal option choice 2520 which allows a search forInterviews sent during a user-specified time range. Search-restrictingbox 2503 allows the Medical Provider to restrict the searching to only aparticular kind of sent Interviews such as those that have been alerted.Search-qualifying box 2504 allows the Medical Provider to enter a nameof a Patient and to thereby confine the list produced to only Interviewsrelating to that Patient. The other, illustrated search-qualifying box2506 provides for a similar narrowing of the search results using thePatient's ID. In one embodiment, there is a further field (not shown) inwhich a Medical Provider can enter a group designation in order to findthe sent Interviews to members of that group.

Table 2514 presents information about the Interviews that have beenfound by the System in response to the given search criteria. Table 2514has columns with headings giving the following information for eachInterview illustrated: Topic Category 2507, Topic Type 2508, Patient'sName 2509, Date Sent 2510 which gives the date at which the Interviewwas sent, Date Retrieved 2511 which gives the date at which theInterviews were retrieved, Alert 2512 which indicates if the Interviewwas alerted, and Reviewed 2513 which indicates if the Interviews werereviewed and, if so, shows the name of the reviewer. The illustratedexample of table 2514 holds two Interviews that were sent on Jan. 9,2001 but not retrieved by either Patient; neither Interview was alerted.

FIG. 26 illustrates an Account settings screen 2600 which may be used toadjust MSP account settings in an embodiment of the current disclosure.Most of the elements in the header bar have been previously described.Settings tab 1006 is highlighted indicating that this button has beenselected by the Medical Provider to show this screen.

Screen section 2601 holds “Your Information” which shows informationrelating to the Medical Provider who is the Account Owner. This includestable 2604 “Your Properties” which holds the name of the Account Owner,the password, the last login date and time, and other Attributes. Alsoincluded is table 2605 “Communication Channels” which holds addressesand contact numbers for various communication channels to reach theAccount Owner. These may include home phone, work phone, work email,pager, and cellular phone numbers.

Section 2603 entitled “Alert Notifications” holds a drop down text box2606. If the Account Owner indicates a desire to be notified of Alertsby means other than just the System screens by checking box 2614, dropdown box 2606 indicates an ordered list of other channels to use forthis purpose. The electable, other channels may include one or more ofwireless pager(s), cell phone(s), PDA(s), email address(es) and soforth.

Section 2602 “Foreign Access” holds information regarding other peoplewho may access this Account Owner's account. The Foreign Access sectionmay also be used to designate which screens may be used by thecorrespondingly identified Foreign Persons. As seen, the Foreign Accesssection 2602 contains a “People” table 2608 in section 2607 which liststhe names, roles and/or privilege expiration dates of the foreignpersons who are to have such account access privileges. Thus inexemplary table 2608, Dr. Bill is given the privileges of a “Back UpMedical Provider” until Feb. 4, 2002, MA Jones is given the privilegesof serving as a Medical Assistant until Jan. 31, 2001, Dr. Jack is giventhe privileges of serving in the Role of Substitute Medical Provideruntil Jul. 23, 2001, and Dr. Joe is given the privileges of serving inthe Role of Consultant until Dec. 31, 2008.

The illustrated section 2609 entitled “Screen Access” holds table 2610with columns entitled “Screen” and “Role Access.” This table indicateswhich screens in the Account are to be given access to by which Roles.Thus, in accordance with the illustrated example, a Backup MedicalProvider can access all screens. On the other hand, only the Main, SendInterview, and List Sent Interview screens can be accessed by theMedical Assistant and the Back Up Medical Assistants.

In an embodiment, section 2611 entitled “Disposition of UnresolvedAlerts” holds table 2612 with columns entitled Alert, How Handled, andDisposition. The first column describes an Alert type and associatedTopic category, the second column indicates how this situation washandled so far, and the third column indicates the follow up dispositionfor purposes of quality assurance and review after it is deleted fromthe System. Thus in row 2615 the clinic's quality assurance group andalso the malpractice insurance carrier are to further review theRetrieval Alert for a high potassium test abnormality handled by afollow up office visit. A Retrieval Alert 2616 for a high cholesterolvalue for which no successful subsequent contact was made is to bemerely stored rather than reviewed by further QA entities. In row 2617the quality assurance group is to review a consultation appointmentfollow up that was not made and was rescheduled. In row 2618 a follow upmammogram that was initially not done but subsequently completed is alsoto be subject to review by the quality assurance group.

FIG. 27 illustrates a Patient Screen 2700 that summarizes a Patient'sInterviews over a period of time and for a given clinic (ABC Clinic) inaccordance with the present disclosure. The title bar has a heading 2701that indicates that this screen is for the Patient and gives thePatient's name and a logoff button 2714. The Patient Menu 2715 holdssection 2702 that shows the name of the medical clinic and applicationthat this screen is a part of, a button 2703 for selecting a table ofall Patient Interviews in the given period, an Open button 2704 forpresenting a screen that details the contents of a selected Interview, ahelp button 2705, and a Settings button 2706 to present a screen for thePatient to see his or her screen and account settings.

In one embodiment, each Patient is given the ability to access and editportions of the information held on the corresponding Patient Screen.The My Interviews button 2703 is highlighted to indicate the Patientwishes to see his Interviews. Table 2712 illustrates the PatientsInterviews and has the following columns: 2707 which, if highlighted,indicates that the Interview on the corresponding row has a RetrievalAlert, “Status” 2708 which indicates if the Interview has been read ornot by the Patient, “Subject” 2709 which gives the title of the Topic ofthe Interview, “From” 2710 which indicates the source of the Interview,and “Date Sent” 2711 which indicates the date that the Interview Dialogreferred to on the row was first sent to the Patient.

In the illustrated example, row 2716 holds an Interview with a potentialRetrieval Alert that has been read by the Patient and reports a Streptest result. Dr. Oakley sent this Interview on Jan. 1, 2001. Row 2717holds an unread Interview reporting on cholesterol test results sent byDr. Marniski on Jan. 2, 2001; it does not have a potential RetrievalAlert. Row 2718 refers to a Interview Dialog in a Sore Throat Follow UpInterview subsequent to an office visit. The Patient has previouslyaccessed and read this Interview; Dr. Oakley sent the Interview on Jan.2, 2001. Row 2719 illustrates a second, unread Interview Dialog for SoreThroat Follow Up subsequent to an office visit from Dr. Oakley sent onJan. 4, 2001; this Interview-Dialog does not have a potential RetrievalAlert. Row 2720 is a Health Maintenance Interview sent by Dr. Brown onJan. 5, 2001 which does not have a potential Retrieval Alert.

FIG. 28A illustrates an example of Patient screen 2800 which may bedelivered to the identified Patient during the carrying out of an AcuteIllness Monitor Interview, in accordance with the present disclosure.Most of the elements of the header bar and side bar of the screen (2800)have been described above. Button 2704 (Open Interview) is highlightedindicating that the Patient has chosen to view this Interview. Thisscreen may be accessed by the Patient selecting the Interview in table2712 of FIG. 27 and selecting button 2704 or by double clicking on thisInterview in table 2712.

Section 2805 holds box 2803 that includes the Interview Topic title,“Sore Throat Follow Up,” a statement “Delivery: 30% Completed,” andprogress box that indicates how much of the Interview Dialogs have beendelivered to the Target (Patient) to date.

Section 2806 contains in the title line 2817 the Interview Dialog numberand question of the Interview. The question is illustrated in 2807 withassociated informative information. Section 2808 “Answer” holds buttonsfor the Patient to indicate his or her answer: For example, 2809 for“Yes” and 2810 for “No.” The Patient may exit this question screen byselecting either 2809 or 2810 or the “Exit Question” button 2820.

FIG. 28B illustrates a delivery of a more complicated Interview to aPatient. Here the MSP desires to communicate a lipid panel test resultto the Patient and advise the Patient of recommendations and informationbased on these results, the Patient's medical information orAttributes—some of which are known to the System and some of which needto be obtained from the Patient at the time of Interview delivery, andcurrent guidelines of an educational authority such as the NationalCholesterol Education Program (Journal of the American MedicalAssociation, May 16, 2001, p. 2486-2497.)

In the illustrated example, the authority guidelines call for threecategories of messages based on the lipid results as follows:

-   -   (1) The lipid test results are fine in relationship to the        Patient's Attributes and no interventions are called for;    -   (2) The lipid tests in relationship to the Patient's Attributes        call for recommendations for changes in the life style of the        Patient—e.g., certain diet, exercise, or weight changes;

(3) The lipid tests are in a range where medications are indicated iflife style changes can not or have not improved the results.

The System-generated decision as to which of these messages will bedelivered to the Patient may be made to depend on the test results andprocessing of these results in terms of Patient Attributes by code, forexample, either on the System's server if the Patient is accessing theinformation on a personal page behind the System's firewall or in acookie delivered by the System to the Patient's own secured web page. Ifalgorithm-requested information such as certain Patient Attributes isalready known to the System (it's in the Database), the executing codemay omit presenting the requests for this already-known information.

An exemplary part of the National Cholesterol Education guidelinesrecommend three LDL goal levels in accord with the Patient's risk ofdeveloping coronary artery disease (CAD) as follows:

-   -   (I) If the Patient has CAD or what is considered an equivalent        such as diabetes mellitus or peripheral arterial disease, an        accepted recommendation is to consider drug therapy if the LDL        is above 100 mg/dL.        In such a situation, if the System's Patient Attributes include        information indicative of this and the LDL is above 100 mg/dL,        no Patient questions need to be presented by the System and a        recommendation compatible with guideline option (3) above, is        presented. Alternatively, the same action results if this        information is not already available and the Patient affirms        question 2838 or 2839. On the other hand, if the Patient has a        combination of risk factors that confer a 10-year risk for CHD        of more than 20% by the Framingham Heart Study parameters (See        e.g., Framingham Heart Study Bibliography,        www.nhlbi.nih.gov/about/Framingham), this recommendation also        applies. The System accesses this 10-year risk as discussed        below.    -   (II). If the Patient has two or more major risk factors        exclusive of LDL and the calculated 10-year Framingham CAD risk        is 10% to 20%, a level of LDL above 130 calls for consideration        of drug therapy. If the Framingham calculated risk is less than        10% for a Patient with two or more risk factors, the drug        determining LDL level is 160 mg/dL.        In such a case, major risk factors that may be considered can        include cigarette smoking, high blood pressure, age, and aspects        of family history. These, if not already known to the System as        Patient Attributes, are asked of the Patient in questions 2834,        2836, 2840 and 2841. If the Patient passes the criteria in        guideline (I) above and the Patient's LDL level is sufficiently        elevated, the System may next process the information of these        questions to see if this LDL level criteria applies. This may be        done in conjunction with the calculation of the Framingham risk        as discussed below.    -   (III) If the Patient has less than two major risk factors        exclusive of LDL as listed above, the LDL level above which drug        therapy is considered is 190 mg/dL. Thus information of        questions 2834, 2836, 2840, and 2841 in conjunction with the        reported LDL level determines if the Patient falls into this        category and which recommendation is presented.        In the above case, calculation of the 10-year risk for CAD with        the Framingham Data may use a point system based on the        following variables: sex, age, total cholesterol, smoker or not,        HDL level, if the patient is under treatment for hypertension,        and the systolic blood pressure. Except for the systolic        pressure, the System should obtain values for all these        variables from the data in tables 2832, 2850, and 2860 or        Database-known Patient Attributes. The System's code can        calculate the Framingham point total exclusive of this factor        and then determine the lower and (if needed) the higher limits        of systolic pressure that would respectively add sufficient        points to produce a 10-year risk of CAD above 10% and above 20%.        The System may then enter these systolic pressure limits into        box 2843 and box 2844 respectively. Upon the patient answering        the question in box 2842 the System may then complete the        calculation of the 10-year risk of CAD and use this value with        rules based on the above considerations to present the        appropriate message to the Patient on the next screen (e.g.,        FIG. 28C).

As an example of such calculations, consider the following: A 58 yearold woman who smokes, is under treatment for hypertension, and has acholesterol of 259, HDL of 45, and an LDL of 140. Since she smokes andis older than 55, she has at least two major risk factors.

Her Framingham Points are therefore:

Age 58 8 Total Chol. 259 5 Smoker 4 HDL 45 1These sum to 18, without consideration of her blood pressure.

A portion of the Framingham point scheme that may be used for systolicblood pressure under treatment is as follows:

Systolic Pressure Points <120 0 120-129 3 130-139 4 140-159 5 >160 6

A portion of the Framingham Point Total versus percent of 10-year riskthat may be used for coronary artery disease is as follows:

10 year risk for PointTotal CAD 18 6% 19 8% 20 11% 21 14% 22 17% 23 22%

Given the above, if her (the Patient's) blood pressure is less than 120systolic no points would be added and her total of 18 points wouldcorrespond to a 10 year CAD risk of 6%. Thus her LDL level of 140 wouldnot call for drug therapy. (The LDL level would have to be above 160 forthis type of recommendation.) The recommendation would change if sheobtained 5 more points from her blood pressure being above 140, if lifestyle changes did not lower the LDL. In an embodiment, if the patientindicates he or she does not know the answer to a question, the Systemautomatically presents to the patient, alternative results based on thevarious, high-probability possibilities for the unknown answer.

FIG. 28D illustrates a patient screen 2896 that may result in anembodiment of this disclosure from the execution of a System HealthMaintenance paradigm for childhood vaccinations. In this case thebirthdates, names, and dates of vaccinations of children are kept in theDatabase. Also there may be a field included for each vaccination whichcan indicate if a vaccination is indicated or not. This field can bechanged to indicate the given vaccination should not be administered toa child in response to other fields being checked. These other fields,again specific for each vaccination, may comprise a field to indicate asevere reaction to a prior dose of the vaccine, a contra-indication tothe vaccine such as egg-allergy, that the vaccine is not needed—e.g.,the patient has already had the illness prevented by the vaccine and isalready immune, or that the vaccine should be held for a period,indicated in an associated field, in response to medication use by thatthe child—e.g., a recent dose of gamma globulin.

Rules responsive to the U.S. Center for Disease Control and/or to otherappropriate, authoritative guidelines for childhood vaccinations may beincorporated into the System. Examples of such rules are as follows:

-   -   VACCINATION RULES and VARIABLES FOR DaPT, DT, MMR, VARICELLA,        PREVNAR, HIB1, POLIO(IP), HEPB and PPD SKIN TESTS: . . . .    -   (i) Hepatitis B (HepB)    -   (1) If 6 wks<Age<19 years, and date of HepBE_(—)1 (i.e.,        Hepatitis B vaccination no. 1). Is null then add Need_HeppB_(—)1        prompt    -   (2) If 4 months<Age<19 years,    -   and date of HepB_(—)1 not, null,    -   and date of HepB_(—)2 is null,    -   and [Now-(Date of HepB_(—)1)]>4 wks then add Need_HepB_(—)2        prompt    -   (3) If 9 months<Age<19 years,    -   and date of HepB_(—)1 not null,    -   and date of HepB_(—)2 is not null,    -   and date of HepB_(—)3 is null,    -   and [Now-(Date of HepB_(—)2)]>8 wks    -   and [[Now-(Date of HepB_(—)1)]>16 wks then add Need_HepB_(—)3        prompt

A. Hib (Hemophilus Influenza Type b Vaccination) Immunization Initiatedat 7 to 11 Months of Age:

-   -   (1) If 7 months<(Age at which Hib1 given)<11 months        -   And date of Hib_(—)2 null        -   And Age<15 months            -   And [Now-(date of Hib_(—)1)]>8 wk then add Need_Hib2                prompt    -   (2) If 7 months<(Age at which Hib1 given)<11 months    -   And 12 months<Age<18 months    -   And date of Hib_(—)2 not null    -   And date of Hib_(—)3 null    -   And [Now-(date of Hib-2)]>8 wk then add Need_Hib3 prompt

B. Hib Immunization Initiated at 12 to 14 Months of Age

-   -   (1) If 12 months<(Age at which Hib1 given)<14 months    -   And Age<59 months    -   And date Hib_(—)2 null    -   And [Now-(date of Hib-1)]>8 wk Then add Need_Hib2 prompt When        children in the System-supported medical practice receive        vaccinations, the date of vaccination and other details such as        lot number may be recorded into the System Database as Patient        Attributes. The System should have a paradigm responsive to a        Patient's age to search this portion of the Database        periodically and apply the above rules. Children who are        significantly behind on their vaccinations may be automatically        selected out with data regarding their parents and contact        channels and an Interview such as illustrated in FIG. 28D may be        automatically instantiated and sent. Note that the System's        “packing” function as described above allows appropriate        Interviews for several children in a same household (e.g., same        family) to be combined in one communication.

FIG. 29 illustrates a Patient-accessible screen 2900 which may be usedby a Patient for viewing and/or responding to a Test Result DeliveryInterview in accordance with the present disclosure. The exemplarydelivery of a test-reporting Interview relates to a chemical screeningbattery. Most of the elements of the header bar and side bar of thescreen have been described above. Button 2704 (Open Interview) ishighlighted indicating that the Patient has chosen to view thisInterview in detail.

Section 2903 indicates the Interview Topic title as being, “ChemicalScreening Battery Test,” and includes a statement “Delivery: 100%Completed,” where the latter is within a progress box that indicatesthat the Interview has been delivered (see again 2803 of FIG. 28A).

Title 2917 indicates that this is Dialog-1 of the Opened Interview. Thissection 2906 of the screen contains a section 2904 which has informationrelating to the test results and a section 2908 which has a button 2905for allowing the Patient to acknowledge to the System, the Patient'sreceipt of the Interview Dialog. Section 2904 comprises of Table 2916which lists the test results and partial explanations of these resultsin 2966 and 2902 as well as providing hyperlinks to additional relevantinformation via area 2920. Table 2916 lists the test names in column2915, the Patient's value of the indicated test in 2914, the normalrange for the test in 2913, an indication of the Patient's valuerelative to these normals in 2912, and a reference and/or hyperlink forfurther information in 2911. Row 2921 is for a ‘Fasting Glucose’ testwith reported value of “160” and normal range of “60-120.” Column 2912indicates this is a “HIGH” value and Comment section 2911 shows thatfurther relevant information is below. Row 2922 shows the value for“Urea Nitrogen” test is “15” relative to a normal range of “6 to 24” sothat this is a “Normal” result. The Patient is referred to anexplanation below. Row 2923 is for a “Haptoglobin” test with value “55”that is within the normal limits of “50-300” and has a hyperlinkreference in the Comment column 2911 to www.lab.com (a fictitiousexample of a laboratory informational page).

Box 2966 holds a statement describing for the Patient the chemicalscreening battery and meanings of the component tests. Box 2902 holds astatement inserted in response to the glucose test being elevated. Box2920 gives a web link for further information regarding the abnormalglucose test.

FIG. 30 illustrates a Patient-accessible screen 3000 which may be usedby the corresponding Patient for viewing and/or responding to a TestResult Delivery Interview for “Lipid Tests” in an embodiment of thecurrent disclosure. Most of the elements of the header bar and side barof the screen have been described above. Button 2704 (Open Interview) ishighlighted indicating that the Patient has chosen to view thisInterview in detail. In an embodiment, this screen 3000 may be presentedin response to the Patient highlighting the Test Delivery Interview inthe table of FIG. 27 and selecting button 2704 or in response to thePatient double clicking the highlighted Interview. Box 3003 shows theInterview Topic title 3016, “Lipid Tests,” and indicates that theInterview delivery is complete in 3004. Title 3017 indicates that thisis Dialog 1 of the delivered Interview Dialog. Section 3006 holds testresult information in 3001 and section 3008 holds button 3035 for thePatient to acknowledge receipt to the System of the delivered InterviewDialog.

Table 3001 in section 3006 holds the test results and partialexplanations of these as well as references to additional relevantinformation. Table 3001 column headings in row 3020 are: the test name,the Patient's value, the normal range for the test, an indication of thePatient's value relative to these normals, and a reference for furtherinformation that is responsive to the Patient's value.

Row 3022 is for the “Total Cholesterol” value for which Patient's valueis “250” versus a normal range of 100-199. The table indicates this is“HIGH” and refers the Patient to comments below (in 3003) for furtherinformation. Row 3021 is for “LDL” cholesterol and shows a value of “99”which is within normal limits. The “Your Result” column informs thePatient of this and the “Comment” column refers the Patient below forfurther information. Row 3023 is for “HDL” cholesterol which has a value“32” versus normal ranges of 35 to 95; this is “LOW.”

Section 3002 holds information relative to high cholesterol values andlow HDL values. Section 3003 has hyperlinks for obtaining furtherinformation on these subjects. Section 3008 allows for a Patient“Answer” by selecting the “Acknowledge Receipt” button 3005.

FIG. 31 illustrates one embodiment for a Patient-accessible screen 3100which may be used for carrying out a Health Maintenance Interview Dialogconcerning follow up for congestive heart failure. Most of the elementsof the header bar and side bar of the screen have been described above.Button 2704 (Open Interview) is highlighted indicating that the Patienthas chosen to view this Interview in detail.

Box 3101 holds the title of the Health Maintenance Topic and section3102 holds the Health Maintenance Interview comprising of:

-   -   i. A greeting to the patient that states that this is a monthly        follow up for his heart condition—3103;    -   ii. The health inquiries—3104, 3105, 3106, 3107, and 3108;    -   iii. A box 3111 asking if he or she desires to be contacted by a        doctor together with a button 3109 to select for a “Yes” answer        and a button 3110 for a “No” answer; and,    -   iv. A button 3118 for submitting the information entered.

The health inquiries in the exemplary Health Maintenance Interviewcomprise four questions 3104, 3105, 3106, and 3107 that have “Yes” or“No” answers that can be indicated by selections in either of the twocolumns of buttons 3112 for “Yes” and 3113 for “No” and a question 3108which requests the Patient record the number of heart beats over aspecified time period by entering a number of heart beats in box 3115opposite the title “BEATS” 3114 and the time period in which these beatsoccurred in box 3117 opposite the title “TIME” 3116. In an embodiment,the Patient is supplied with a manually-operate-able or computerinteroperable device (e.g., a Holter monitor, not shown), that canrecord and count instances of heartbeats. These should be monitoredunder standard conditions, such as in a resting basal state for a knownperiod of time. The number of heartbeats for this time period underbasal conditions can reflect heart function and can be compared overtime (automatically by the System) as a index of health. In anembodiment, a Topic Dialog can contain a rule which may be used by theSystem for monitoring health where the rule involves the relativepercent change of the pulse rate under different, standardized exerciseloads. Information for this can also be recorded and used by the Systemas an indirect monitor of cardiac health over time. Thus, if a Patientexercised at a set treadmill speed and slope with an average pulse rateof P1., and by increasing the rate and or slope to another set ofstandard values had an increase in pulse to an average steady state rateof P2, the measure reported for the index of health status could beautomatically evaluated by the System with a status defining rule of theform:

Status at a given time=(Constant)×(P2−P1)/Pav

where Pav=(P2+P1)/2.

Such a rule could automatically produce various actions by the System,such as setting of various alert(s) and changing of one or more DeliveryStrategies, based on pre-specified ranges. As another embodiment of thisconcept, the Patient may be asked by an Interview to report the relativevariability of the pulse rate, dP, at different pulse rates, P, or dP/P,as an index for monitoring heart status.

FIG. 32 illustrates a Patient-accessible screen 3200 which may be usedfor allowing the corresponding Patient to edit and/or reviewpersonal-data settings associated with Patient. Most of the elements ofthe header bar and side bar of the screen have been described above.Button 2706 (My Account Setting) is highlighted indicating that thePatient has chosen to view his or her account settings.

Section 3201 holds Patient information in tables 3202, 3203, and 3220.Table 3202 holds the Patient's name and other personal and medicalinformation as indicated. Table 3203 holds information regarding thepresence or absence of medical conditions and table 3220 holdsinformation regarding past hospitalizations and operations. In anembodiment, this information may be entered into the System Database bymedical personnel and/or by allowing the Patient to have full or partialinteraction with an electronic medical record.

Section 3211 holds first information 3204 regarding variouscommunication channels by which the Patient may be reached in the formof a table. Column 3205 indicates the Patient's preferred order of useof the listed channels, 3206 indicates the name of the channel, 3207indicates whether or not the channel is currently active (currentlyusable), 3208 indicates the channel address, 3209 indicates the probableavailability times of the channel during the week, and 3210 indicatesthe believed availability times of the channel during weekends.

FIG. 33 illustrates an Administrator-accessible screen 3300 which may beused by an Administrator to locate and add Patients to a System inaccordance with the present disclosure. The header bar 3301 holds afirst section 3303 identifying the Administrator and a logoff button3304. The side bar holds a title area 3305 indicating that it is theAdministrator's Menu and has a section 3306 indicating that this is an“ABC Medical Clinic Application.” Button 3307 may be used to locate oradd Patients, button 3308 to Edit Patient Attributes, button 3309 toobtain help in the use of the System, and button 3310 to access AccountSettings. Button 3307 (Locate/Add) is highlighted to indicate thisscreen is for respectively locating or adding a Patient in/to the SystemDatabase.

Section 3311 holds a text box 3310 for entering the name of a Patient(or a query for a name, e.g. Bill L?e*) and text box 3312 for enteringthe ID (or a query for such an ID, e.g. ABC-P-L?e*) of the Patient. TheAdministrator may enter the Role of the searched for/added Person intext box 3330 if desired. If pick area 3323 is highlighted the Systemwill search for a person with the identifiers placed in the above textboxes; if pick area 3314 is highlighted the System will search for agroup using these identifiers. The Administrator initiates the search bypressing the Find button 3315. Result-Listing box 3322 lists names ofpeople that come closest to satisfying the search criteria entered inthe text boxes. If a group search is sought by picking 3314, list box3322 changes to show group names that come closest to the entered searchcriteria. If the Administrator is inputting a new person or group, theAdministrator selects button 3319 to add the name and/or identifierlisted. The Delete button 3340 allows deletion of groups or Persons. Inan embodiment the Administrator may use the Find and Add New buttonswith the Name list 3322 to form new groups.

FIG. 34 illustrates another Administrator-accessible screen 3400 whichmay be used by an authorized Administrator to edit Patient data in theDatabase of System in accordance with the present disclosure. Most ofthe elements in the header bar 3301 and side bar 3305 have already beendescribed. Button 3308 is highlighted to indicate that the Administratorhas selected it to view and edit Patient information.

Section 3401 comprises a first section 3402 which allows for editing ofPatient Information and a second section 3403 which allows for editingof Channel Information. The Patient Information section holds a table3404 listing Patient data such as name, birth date, and insuranceinformation. Section 3403 holds access and address data for variouscommunication channels which may be used to make Interview deliveryattempts to the Patient. The Administrator can use the screen 3400 tomodify, add to, or delete from, the Patient and Channel data held by theSystem Database as may be appropriate.

FIG. 35 illustrates an Account Settings screen 3500 which may be used bya so-authorized Administrator to edit the System account settings ofanother Administrator and/or of his or her information settings in anembodiment of the current disclosure. Most of the elements in the headerbar 3301 and the side bar 3305 have already been described. Area 3501holds table 3502 that lists Attributes pertaining to the targetAdministrator's account. These may include name, password, phonenumbers, name of back up administrator and means of contacting thistarget person.

FIG. 36 illustrates a Chart Note window 3600 which may be displayedand/or used in an embodiment of the current disclosure for viewingand/or editing chart note data. When a user of the System selects aChart Note-activating box such as 1204 in FIG. 20, the correspondinglystored Chart Notes for the identified Patient may be presented asillustrated in FIG. 36. The title bar 3601 indicates that theinformation shown is a Chart Note. Buttons 3603 allow the user to scrollthrough the Chart Notes that are stored on the System Database for thePatient being considered. Box 3602 indicates which Chart Note is beingviewed and total number of Chart Notes present in the System for theidentified Patient. The users account name is indicated in box 3604.

An example of a Chart Note is illustrated in area 3605. In the instanceillustrated, the Chart Note is for the Patient Sylvia Patch and wasplaced into the System Database on Dec. 4, 2000 by Dr. Lee Jones. Dr.Jones noted that the Patient was diagnosed as having recurrent urinarytract infections and was treated with furadantin. He also indicated thatshe is allergic to penicillin and that a culture is pending.

Button 3606 (Add) allows the user to add a new Chart Note; button 3607(Delete) allows the user to delete a Chart Note; and button 3608 (Close)allows the user to close the given Chart Note window 3600 and return toworking on the previously displayed screen.

FIG. 37 illustrates a Patient Information window 3700 which may bedisplayed when a System user selects a Patient Information box, 1202 forexample in FIG. 12. The title bar 3701 indicates the informationillustrated is information regarding the Patient. Table 3702 holds basicidentifying and medical information for the Patient such as name,height, weight, medications and medication allergies. Table 3703 holdsinformation regarding the medical illnesses or conditions the patienthas or does not have. Button 3705 allows information regardinghospitalizations of the Patient to be obtained from the System Databaseand displayed. Button 3706 allows information regarding prior surgeriesof the Patient to be obtained from the System Database and displayed.Button 3704 allows information regarding prior office visits of thePatient to be obtained from the System Database and displayed. In anembodiment, information in the above categories may be obtained atremote workstations using wired or wireless links to the System Databaseand/or to external Databases, if any.

FIG. 38 illustrates a Communication Channel window 3800 which may bedisplayed when a System user selects, for example, a CommunicationChannels box such as 1203 in FIG. 12. The title bar 3801 indicates thatthis is Communication Channel information that indicates the variouscommunication channels by which the Target (e.g., a Patient) may bereached. Table 3808 has the following column headings: Column 3802indicates the Target's (e.g., Patient's) preferred order of use of thelisted channels, 3803 indicates the name of the channel, 3804 indicateswhether or not the channel is currently active (currently useful forreaching the Target person), 3805 the channel address, 3806 theavailability times of the channel during the week, and 3807 theavailability times of the channel during weekends.

The present disclosure is to be taken as illustrative rather than aslimiting the scope, nature, or spirit of the subject matter claimedbelow. Numerous modifications and variations will become apparent tothose skilled in the art after studying the disclosure, including use ofequivalent functional and/or structural substitutes for elementsdescribed herein, use of equivalent functional couplings for couplingsdescribed herein, and/or use of equivalent functional steps for stepsdescribed herein. Such insubstantial variations are to be consideredwithin the scope of what is contemplated here. Moreover, if pluralexamples are given for specific means, or steps, and extrapolationbetween and/or beyond such given examples is obvious in view of thepresent disclosure, then the disclosure is to be deemed as effectivelydisclosing and thus covering at least such extrapolations.

By way of a first example, although the information presentation and/orexchange interfaces shown in FIGS. 8A-38 are presented in the form ofvisual windows or screens that are suitable for transmission over theInternet or a like link and for display on a desktop or portablecomputer, other visual and/or non-visual, information transmissions,presentations and/or exchanges via appropriate interfaces are within thecontemplation of the present disclosure. For example, small-screencommunication devices such as third-generation (3G) cell phones, PDA's(personal digital assistants), pagers and the like may call for terservisual presentations in view of their limited display and/or user-inputcapabilities. The System Database may store data for each kind ofchannel indicating the limitations of that channel's transmissioncapabilities and further data for each kind of communication device(e.g., cell phone, PDA, etc.) indicating the limitations of thatdevice's user interfaces. The Target user's familiarity with using eachparticular kind of communication device may further be stored andadaptively used for communicating with the target. For example, anelderly Patient may own a 3G cellular telephone but may not know how touse the more advanced visual and/or keyboard and/or pointer/pen devicesof such a communications device. Instead, the communications TargetPerson (e.g., Patient) may only know-how/be-able to use a voice-onlyinterface, or voice combined with a touch-tone keypad. The System shouldadaptively compensate for such user-centric preferences and provide itsInterviews, Alerts and/or other communication exchanges accordingly.

Additionally, as has already been indicated in the context of FIG. 1A,at given times and/or locations (e.g., a physician driving to thehospital in heavy traffic) the communications Target may not be disposedto receiving and/or responding to complicated transmissions ofinformation. The System may adaptively compensate for such user-centriclimitations by giving only short Advisements of pending Alerts or othersuch delivery attempts and the System may schedule a series of reminderAdvisements as may be appropriate. (E.g., the System may be aware thatthe Medical Service Provider is on the ski slope with only a pageravailable for receiving advisements. If the medical situation is anurgent one, the System may automatically decide to beep the pager every5 minutes until responded to and may also make similar contact attemptsto a back-up physician listed-in the System Database.)

To recapitulate some of what was initially introduced in FIG. 1A andthen further elaborated on in other discussions herein, effectivecommunications within a medical practice can be blocked by manyobstacles (e.g., 98 of FIG. 1A), and such obstacles may be overcome by(or at least recognized by and appropriately reacted to)machine-implemented methods and automated systems that provide, but arenot limited to, the functions of: (1) finding a communications channel(cell phone, email, pager) that is not only operating at a time that acommunications delivery is to be attempted, but is also convenientlyuseable by the targeted recipient (e.g., Patient, physician, lab tech)for the kind of exchange that is to be carried out (e.g., simpleadvisement or alert versus a long and complicated Interview); (2)adaptively conforming the message content to the limitations of thechosen communications channel and the current disposition of thetargeted recipient (e.g., Patient is distressed, physician is driving acar, etc.); (3) adaptively finding the targeted recipient, particularlyif that person tends to be highly mobile and/or travel patterns orcommunications-channel preferences change over time; (4) verifying thatthe targeted recipient actually received the delivery-attempt within anapplicable time limit, if any (e.g., Patient activates acknowledgmentmeans such as 2905 of FIG. 29; physician disposes of or delegates anAlert via the Alert Summarizing Screen of FIG. 10A or via a substitutevisual or nonvisual interface means); (5) automatically recognizing thatan urgent or non-urgent message delivery-attempt was not timelycompleted (e.g., in-completion feedback path 95 of FIG. 1A) andadaptively alerting responsible entities of the in-completion based onurgency of the in-completion (e.g., physician may be automaticallybypassed and follow up can be automatically delegated to an MA if aroutine test result was not picked up with acknowledgment by a Patient);(6) automatically recognizing that an urgent or non-urgent action itemtask was not timely completed (e.g., in-completion feedback path 95 ofFIG. 1A) and adaptively alerting responsible entities of the taskin-completion based on urgency of the in-completion (e.g., physician maybe automatically bypassed and follow up can be automatically delegatedto an MA if a routine Health Maintenance test was missed by a Patient);(7) automatically recognizing that an urgent action item task wascompleted (e.g., passing alerted test result 65 of FIG. 1A throughfilter 87) and adaptively alerting responsible entities of the taskcompletion based on urgency of the completion (e.g., alerting MD 20 viaAlert Summary of FIG. 10A to review 26 the alerted result condition);(8) automatically recognizing that an urgent change or non-change ofcondition has occurred by virtue of information gathered during anautomated or manually-assisted Interview (e.g., if Patient responds NO2810 in FIG. 28A during automated or manually-conducted Interview wherephysician expected positive progress prior to Interview) and adaptivelyalerting responsible entities of the changed or unchanged conditionbased on the urgency of the change or non-change (e.g., alerting MD 20via Alert Summary of FIG. 10A, i.e. row 1024, to review 26 the alertedcondition); (9) adaptively altering Interviews in response toinformation obtained from earlier Dialogs or from other sources; (10)adaptively adjusting the timing of deliveries of further Dialogs inresponse to information obtained from previous Dialogs; (11) adaptivelydelivering Interview Dialogs in an order and/or timing defined bysystem-changeable priority settings and/or according to availablechannel bandwidth and/or according to permitted times for delivery; and(12) when delivering a first message through a given channel, if thechannel-use rules permit, “packing” other Dialog messages that are to bedelivered via that channel to a given patient or household so that allsuch packed Dialogs can be simultaneously delivered if the connectionattempt is successful.

Referring to FIG. 39A, there is illustrated an Interview Data Structure3900 that may be developed, recorded and/or transmitted as a set of oneor more data signals within one embodiment of a System which is providedin accordance with the present disclosure. The Interview Data Structure3900 may be comprised of one or more Dialog Data Structures such as thethree shown for purposes of example at 3910, 3920 and 3930. Referring toDialog-0, it may be seen that such a Dialog Data Structure (3910) may becomprised at least of a Decision Tree structure 3915 as well as at leastone if not both of a Presentable-Data structure 3912 and aCollected/Collectible-Data structure 3917. While a particular dialog(communication) is being conducted with a corresponding recipient(Target), the current state of the respective, Dialog Data Structure(e.g., 3910) may be deemed to be moving progressively down its DecisionTree (3915) in response to various events or non-events that may takeplace during the attempted or successful carrying out of the dialog.

In the example shown at 3910, the current state of Dialog-0 is indicatedby the hollow circle at position 3916 within the Decision Tree structure3915. For the dialog to have gotten to this particular state 3916, it ispossible that contact has already been successfully made through aparticular channel (e.g., conventional telephone) with the Target andthat default and/or event-selected ones of declarations and/or questionsmay have been posed to the Target. For example, if the Presentable Datastored at 2807′ (“Are you feeling better?”) was presented to the Target,the Target may have responded with an indication (e.g., spoken or touchtone) representing the Collected Data shown by example at 2810′ (“NO,I'm not feeling better.”). As a result of that response (2816′), theDecision Tree 3915 of Dialog-0 may have decided that it is time to soonterminate Dialog-0 (3910) and the Tree may have further generated aflow-controlling indication which indicates that one or the other ofInterview flow paths 3918 and 3919 should next be taken to a respectiveone of next Dialogs 3920 and 3930. Each of respective Dialogs 3920 and3930 has its own corresponding Decision Tree (e.g., 3925 or 3935) andone or both of its own respective Presentable Data storage regions (3922and 3932) and its own respective Collectible Data storage regions (3927and 3937).

The current state (e.g., 3916) achieved within a current Dialog DecisionTree (3915), and/or the data held in the Collected Data of region (3917)of the Dialog Data Structure 3910, and/or the lack of all or aparticular item of data can be used to automatically and adaptivelycontrol one or more aspects of the way that the Interview-conductingSystem (not shown, see for example FIG. 40A) will dispense informationand/or will react to the Collected Data (e.g., 3917) or lack thereof. Itis seen under Interview-flow path 3939 that the one or more adaptivebehaviors of the Interview-conducting System can include the automatedmaking of decisions regarding: (a) Which next Dialog, if any, should besent next?—this being an example of Adaptive Interview Flow, 3941; (b)How should the next Dialog be delivered—by telephone, email and/orotherwise?—this being an example of Adaptive Delivery Strategies, 3942;(c) When should the next Dialog be delivered?—this being an example ofAdaptive Scheduling, 3943; and (d) What should the Presentable Contentof the next Dialog be?—this being an example of Adaptive Content, 3944.(The same kinds of machine-implemented, adaptive options may beassociated with the Interview-flow path 3929 emanating from theillustrated, Dialog-1 Data Structure 3920, and paths 3918, 3919emanating from the illustrated, Dialog-0 Data Structure 3910.).

Referring to FIG. 39B, there is shown an example of a simple Dialog 3950that may be provided in one embodiment according to the presentdisclosure. (Other, more sophisticated representations of possibleDialogs are provided in the accompanying Exhibits 1-3.) For theillustrated Dialog 3950, entry point 3951 is taken at a time determinedby a System Scheduler (not shown). Decision juncture 3952 determineswhether a connection (channel-pickup) has been successfully made. If theanswer is No, step 3954 stores information regarding the contact attempttime and/or the method used to try to make the contact in a history logsection (e.g., 3917 of FIG. 39A) of the current Dialog Data Structure3950 (partially shown). A Decision-Tree path 3955 is then taken to step3956. In step 3956 an indication is produced for transmission to theScheduler to indicate to the Scheduler that it should attempt to deliverthe whole (or an unfinished part, in one embodiment) of the currentDialog (e.g., Dialog-0) at a future time, which future time will bedetermined according to scheduling rules for the current Dialog(Dialog-0) and/or which future time will be determined according toDelivery Strategies that have been pre-specified (in the System) for thecurrent Dialog (Dialog-0). In one embodiment, additional provisos areprovided for determining whether the next attempt may be carried out atall and these provisos (which should be set forth in the Schedulerrather than in the Dialog Data Structure 3950) may include one or moreof the following: having the Scheduler determine whether the number ofDelivery Attempts so far is less than or equal to a definedAttempts-Maximum value for the current Dialog or its encompassing Topicor encompassing Application; having the Scheduler determine whether thenumber of Hang-ups (disconnects) so far for the current Dialog is lessthan a prespecified Hang-ups Maximum value associated with the currentdialog (Dialog-0) and/or whether the number of Hang-ups (disconnects) sofar in a relevant time period exceeds a prespecified Hang-ups FrequencyMaximum value associated with the current dialog; having the Schedulerdetermine whether the number of No-Answers thus far is less than orequal to a prespecified No-Answers Maximum value associated with thecurrent dialog and/or whether the number of No-Answers so far in arelevant time period exceeds a prespecified No-Answers/Busy's FrequencyMaximum value associated with the current dialog; and having theScheduler determine whether the time that the current instantiateddialog (Dialog-0) has been pending within the System is less than aspecified Time-out Maximum value associated with the current dialog. Ifone or more of these provisos is violated, the System may automaticallygenerate a Retrieval Alert if such a Retrieval Alert is called for underthe relevant System, Application and/or Topic Rules. Moreover, theautomatic generating of a Retrieval Alert may be predicated on havingthe Scheduler determine the number of times that a telephone answeringmachine or a like, automated message receiving agent of the Target wasreached and determining whether such number of agent-reaching timesand/or the frequency of such agent-reaching events qualifies for thegeneration of a Retrieval Alert under maximum values and/or rulesassociated with the corresponding, Interview.

At next step 3959, the Dialog 3950 is exited and control is returnedback to the Scheduler. The information and/or lack of informationcollected by the Dialog thus far and/or the state of the Dialog thus faris also returned back to the Scheduler (e.g., via a software pipe).

If the answer had instead been “Yes” at decision juncture 3952, then atthe following step 3963 the time that the contact was made would bestored in the Dialog History Log. At step 3964, a DecisionTree-determined statement and/or question is presented. In this example,the presented question is, “Are you feeling better?”.

At next juncture point 3965, at least one of three things may happen.The targeted recipient may fail to answer or may hang up or theconnection may disconnect due to other reasons. These possibilities arerepresented by juncture exit path 3966. At step 3967 the no-answerand/or hang-up time and/or disconnect time is stored in the DialogHistory Log. Then path 3955 is taken through step 3956 for exit at 3959.

If the answer “Yes” had been provided at junction 3965, then Dialog path3967 would be taken to step 3971. In step 3971 the answer provided bythe recipient is recorded in the Collected Data area. An indication isgenerated for the Scheduler to schedule a next appropriate Dialog (e.g.,Dialog-1) at an appropriate future time, where each of the identify ofthe next appropriate Dialog and the next appropriate future time may beproduced in view of the Collected Data thus far and/or the lack ofcertain Collectible Data and/or in view of scheduling rules that areassociated in the System with the planned next Dialog. The results ofstep 3971 are passed through exit point 3959 for handling by theScheduler.

If the answer at juncture point 3965 had instead been “No”, then path3968 would have been taken to step 3972. In step 3972, the obtainedanswer (patient information) is recorded in the Collected Data area ofthe Dialog. An indication is further generated for the Scheduler toschedule a next appropriate Dialog (e.g., Dialog-2) at an appropriatefuture time in view of the Collected Data or lack thereof and/or in viewof scheduling rules provided within the System for the next plannedDialog. Also within step 3972, an indication to generate an InformationAlert may be created if appropriate under the Dialog-governing rules ofthe System. The Decision Tree status (current state) and/or CollectedData are then returned to the Scheduler by way of exit point 3959.

FIG. 40A is a block diagram showing a structuring for an adaptive,information-dispensing and information-collecting System 4000 which maybe provided in accordance with the present disclosure. Externalinformation sources such as test labs, etc. may provide test results orother information in corresponding, machine-readable formats asindicated at 4005. A format converter 4010 receives theexternally-sourced transmissions, analyzes them and converts them intoan appropriate System-compatible format. In one embodiment, thisSystem-compatible format uses XML tags embedded withinconverter-produced, text files (e.g., .txt file extensions) where thetags identify the respective meanings of various text strings providedwithin the various converted forms 4012. The converted forms are storedin an UpLoader Queue 4015. In one embodiment, each converted form 4012should have at least patient identifying information (e.g., <PatientID>) and topic identifying information (e.g., <Topic ID>). The convertedforms 4012 may include further tagged objects representing other piecesof information (not shown) that may be useful to the System 4000 suchas: <MSP ID>, <Application ID>, <Action Requested>, and so forth.

A system Up-Loader 4018 repeatedly scans through the forms 4012 storedin the Up-Loader Queue 4015, looking for forms that may be currentlyacted upon in accordance with applicable UpLoader Rules 4019. In oneembodiment, UpLoader Rules 4019 are Topic-driven, meaning that eachTopic of each Application can have its own unique UpLoader Rules. Theactions that may currently be taken by the Up-Loader 4018 may includeconverting one or more of the queued forms (4012) into instantiableinterviews 4021 or new patient records 4022 or making modifications topre-existing patient records. The applicable UpLoader Rules 4019 maydefine which UpLoad-generated Interview is to have its NeedsReview flagset to true rather than false. UpLoad-generated Interviews which havetheir NeedsReview flag set true are UpLoaded into region 4021 becausethey are deemed to need human intervention (4024) while others of theUpLoad-generated Interviews may be routed without intervention intoregion 4025 (no human intervention needed). Some or all of the queuedforms (4012) within the Up-Loader Queue 4015 may be stored therein fromSystem-internal sources 4011 (e.g., created by the System Administratorin System-compatible format). Certain ones of the queued forms (4012)may remain in the Up-Loader Queue for relatively long periods of time(e.g., months) and may be repeatedly acted upon by the Up-Loader 4018 asvarious events occur (e.g., a new group of persons reach age 65). Otherones of the queued forms (e.g., 4013) may be discarded into a waste bin4014 after having been acted upon just once by the Up-Loader 4018 oreven if they had not been acted upon at all by the Up-Loader 4018 (e.g.,the System Administrator decides to discard them).

Aside from being able to generate instantiable interviews 4021 and newor modified Patient Records 4022, the Up-Loader 4018 can also directlygenerate (4026) Instantiated Interviews 4025 directly from forms 4012 inthe Up-Loader Queue if such forms provide all the necessary informationfor completing an instantiated interview. In one embodiment, aninstantiated interview (4025) is defined as having all the informationfields therein completed, where such completed information fields arethe ones necessary for appropriately scheduling and conducting aninterview. Examples have already been given herein for cases where humanintervention 4024 is called for in order to complete an instantiableinterview 4021 and thereby convert it into an instantiated interview4025. The case of FIG. 12, for example, can represent a situation wherea System-external laboratory (4005) has electronically sent its labresults through converter 4010 into queue 4015 and the Up-Loader 4018has generated both an instantiable interview 4021 and a correspondingalert 4023, where the latter lets the doctor know thathuman-intervention 4024 is being called for. When the doctor 4075 checksan alerts-summarizing mechanism (e.g., the screen shown in FIG. 10A oranother alert-reporting mechanism), he or she can respond to thegenerated alert (4023) by filling in the necessary information or bydelegating the task to an assistant (4076). The interventions 4024 forconverting instantiable-interviews (4021) into instantiated ones (4025)may take place through the interactions of the MSP, MA and/or otherPersons with corresponding client interfaces 4028 and screen drivingclients 4027. The latter screen driving clients 4027 have access topatient records and other information within the System database 4050for thereby filling in parts of the instantiable-interviews (4021) withdefault or already-obtained information as may be appropriate. It iswithin the contemplation of the disclosure that certaininstantiable-interviews 4021 do not need human intervention 4024 and cantherefore be generated automatically by the System 4000. Patient recordinformation 4022 and/or other information that may be needed forconverting an instantiable interview 4021 into an instantiated one 4025may be provided directly from the database 4050 without humanintervention.

In some instances, Dialog-blocking or interview-blocking means such as4031 and 4033 may be established within the System for automaticallypreventing certain instantiated or instantiable interviews from gettingthrough to the Scheduler 4040. For example, a given patient may requestthat no Health Maintenance reminders regarding his smoking habits besent to him. Each time the System batch-produces a series of HealthMaintenance reminders for sending to smokers or smoker groups, thatparticular patient's blocking mechanism 4033 should come into effect andact to block out the undesired interview that is directed to him. Theinstantiation of that particular Interview either never happens (4031),or if it does happen, the instantiation of that particular Interview isdestroyed (4033).

The System Scheduler 4040 automatically scans through the Database 4050looking for instantiated interviews 4025 that are not blocked (4033).The Scheduler 4040 prioritizes such instantiated interviews and decideswhich kind of Channel to try to send respective ones of the Dialogs inthose interviews through and when. Each communications channel (e.g.,telephone, cell phone, pager, email, etc.) may have its own specificChannel Manager. For sake of example, two such managers are shown at4061 and 4062.

Certain ones of the System's channels may have more restrictedbandwidths than others. Say, for example, that Channel Manager 4061manages a small number of telephone lines 4065 available to the System.The Channel Manager 4061 is aware of this situation. When the ChannelManager 4061 receives a series of requests from the Scheduler 4040 formoving a current set 4064 of already-prioritized Dialogs through thelimited-bandwidth channel 4065, the Channel Manager 4061 automaticallymakes certain decisions about which Dialogs will get through the channel4065 and which won't. The Channel Manager 4061 may also elect to use achannel-specific “terse” mode for delivering the Dialog rather than a“verbose” mode, as may be appropriate for the channel bandwidth. In oneembodiment, each Channel Manager 4061, 4062, etc.) organizes itsrespective set 4064 of Dialogs received from the Scheduler 4040 firstaccording to priority of Application (e.g., an emergency room (ER)clinic application will generally have higher priority than asmoking-management clinic) and then according to Topic priority withineach of the selected Applications. Attempts will then be made to contactthe corresponding targets (e.g., Patient-X and Patient-Y) through thecorresponding channel 4065. As time or other events occur, certain onesof the Dialogs in set 4064 may become ineligible for furtherdelivery-attempts and new Dialogs may be added to set 4064. Thus, set4064 can be dynamically changing over time.

It is assumed in the case of illustrated channel 4066 that successfulcontact 4068 has been made with Patient-Z and that Dialog 4069 wasdelivered to Z and completed. The completed Dialog 4069 is then returnedvia path 4070 through the corresponding Channel Manager 4062 forultimate reflection (4070′) into one or more parts of the database. Forexample, new information that Patient-Z may have provided via Dialog4069 may be recorded into Patient-Z's records 4071 for future use by theSystem. Delivery-Attempts information acquired during the interaction4068 with Patient-Z may be reflected back into the delivery strategies4072 that are stored within the database for Patient-Z. Particularpieces of information or lack thereof may cause the System to generateAlerts 4073 in response to what happened when Dialog 4069 was deliveredor attempted to be delivered to Patient-Z. The states (e.g., internalcontents or decision trees) of still-pending, instantiated Interviews4025 may even be modified (under the applicable Application Rules 4074)by the fedback data signals 4070′ resulting from the delivery-attempt orconduction of Dialog 4069. Application Rules 4074 and/or Topic Rulesand/or other processing rules may be used to control how the feedbackinformation 4070′ obtained from the Channel Manager 4062 is processed.For example, certain ones of Alerts 4073 may be directed to the AlertSummaries of specific medical service providers (4075) while others aredirected to other real people (4076) and yet others, which can be dealtwith automatically under an Application's policies, may be directed tomachine-implemented agents such as 4078.

The illustrated machine-implemented Agent 4078 acts as a sort of virtualdoctor or nurse that automatically scans through the database 4050looking for prespecified patterns of information that, according toAgent Rules 4079, justify the fully-automated formulation ofinstantiated interviews 4025 for transmission to patients or otherpersons. For example, health maintenance interviews may be automaticallyscheduled for certain patients whose records 4022 indicate they havereached a particular age where an examination may be warranted. Agent4078 handles these mundane tasks thereby freeing the human participants4075 and 4076 of the System to focus their attentions on higher prioritymatters. In one embodiment, if human intervention is nonetheless neededunder clinic policies or otherwise, the Agent 4078 completes all thework it is allowed to do and then notifies an appropriate human beingfor permission to send the formulated Interview with or withouthuman-entered modifications.

Referring to FIG. 40B, one embodiment 4000B of a System in accordancewith the disclosure is illustrated for purposes of explaining securityand scalability. An Application Server 4080 functions to, in essence,protectively surround the Database 4050′ of this embodiment 4000B andcontrol what goes in or comes out. Substantially all data inputs 4081and data outputs 4082 that involve sensitive information are forced togo through the Application Server firewall so as to prevent unauthorizedpersons from interfering with System data, or interfering with Systemoperations or receiving information they are not supposed to receive. Aninterface of the Application Server 4080 routes input and/or outputsignals 4081/4082 along paths to/from different, System-definedApplications, such as the illustrated App-1 through App-4. Logical roleassignments, such as indicated at 4091 and 4092 are made betweenrespective Person records 4093 and the different Applications so thatread or write access to data is controlled on a per-Application basis,depending on the Role of the given Person under that particularApplication for which data is being communicated. In essence,appropriate ones of Person records 4093 are inherited by each respectiveApplication under an appropriate one or more Roles relative to thatApplication (e.g., new Role 4099 for New Application N) so that samePerson records do not have to be duplicated and duplicatively updatedfor each Application. Each Application may have its own specific Rules4083 for controlling the instantiation of interviews under thatApplication. Each Application may have its own Topic definitions and/orTopic rules 4094 forfurther controlling the instantiation of interviewsunder respective Topics. In one embodiment, Application Rules, Topicdefinitions and Topic rules are not inherited into Applications butrather copied for or custom built for each new Application. Variousboilerplate interviewtemplates and Dialog templates 4095 may be providedwithin the System 4000B by inheritance or copying through respectiveTopics (4094) and may be used for facilitating the formulation ofInstantiated Interviews. For the instantiation of certain Interviews,semi-manual or agent-automated formulation activities 4097 may need totake place under the rules of the respective Application. When a newApplication, e.g., App-N, is to be added to the System 4000B, additionalRole assignments such as 4099 can be easily made without having togenerate new Person records 4093. Corresponding Application Rules 4083and/or Topic Definitions and Topic Rules 4094 may be copied to, orcustom-constructed for the new Application. Thus, a scalable and secureSystem 4000B may be provided for formulating and dispensinghealth-related information to individual patients or groups of patients;for collecting health-related information from such patients; and fortaking appropriate and timely action in response to patient feedback orlack thereof.

Given that descriptions have been presented above about a variety ofaspects that may be present in Service Providing Organization SupportingSystems which are structured in accordance with the present disclosure,it is now easier to complete the description of FIG. 10B, whichdescription was started above. The signals and actions flowchart 1050shows that a number of different events 1060 may occur within a Systemto lead to the creation (1070) of an Alert 1080 and a correspondingAlert Summary 1080 a or the creation of other kinds of notifications,which may be treated, at least in the context of the Alert-summarizingPresentations as if they were Alerts. One of the illustrated,alert-invoking events is Message Spoilation 1061. The latter can occurwhen for one reason or another, a message times-out (it rots, so tospeak) before the System even had a chance to carry out adelivery-attempt. The created alert that is associated with this kind ofevent (1061) is referred to herein as an “Unsent Alert”. A possibleunderlying cause (1055) may be that the communication channels whichwere planned for making the delivery-attempts were all busy servicingmore pressing messages (higher priority messages) and their bandwidthswere too narrow to allow the now-spoiled message to get through.Delivery-strategies of the corresponding Application may have to bemodified if too many important messages spoil in such a way.

A second of the illustrated, alert-invoking events is Message Refusal1062. The latter can occur when for one reason or another, certain ruleswithin the System (see items 4031 and 4033 of FIG. 40A) cause apartially instantiated or fully instantiated Interview from getting tothe scheduler (4040) for subsequent attempt of delivery. An underlyingreason may be an uncooperative Patient who has asked that the respectivemessage be “blocked” from annoying him or her. The created alert that isassociated with this kind of event (1062) is referred to herein as a“Blocked Alert”.

A third of the illustrated, alert-invoking events is Message NonRetrival1063. The created alert that is associated with this kind of event(1063) is referred to herein as a “Retrieval Alert”. A MessageNonRetrieval event 1063 can occur due to any of a number ofpossibilities. The telephone answering-machine of the message Target(e.g., Patient) may be overfilled or broken. The Patient may be too sickto respond. System-kept-histories of what has happened in the past maybe helpful in determining what the more likely underlying cause is. ThePrimary Care Provider may nonetheless be held ultimately responsible andthus may want to be alerted to the Message NonRetrieval event 1063.

A fourth of the illustrated, alert-invoking events is a CollectedInformation Triggering event 1064. The created alert that is associatedwith this kind of event (1064) is referred to herein as an “Info Alert”.A Collected Information Triggering event 1064 can occur due to any of anumber of possibilities. New, abnormal test results may have come infrom a laboratory. The Patient may have reported new symptoms in thecourse of responding to a delivered Interview. The Patient may havereported that he/she is doing worse or not doing better at some timepoint in the follow up concerning a condition known to the System.

Item 1069 indicates that there can be other events which are reported tothe Alert/Notification Creating mechanism 1070 of FIG. 10B. TheAlert/Notification Creating mechanism 1070 can rely on the identity ofthe alert invoking event 1060 and/or on various Target-centric rules(discussed above) and/or Application-centric rules and/or MSP-preferencerules and/or Topic-centric rules to determine whether or not to generatea corresponding Alert 1080, and if so, what Alert-summarizing Note 1094should be used, and/or what Alert-Handling Action 1088 is to berequested of one or more of the Alert recipients and/or and if priorityis to be set (1082), what base priority to establish. Referring tomomentarily FIG. 10A, it may be seen from the illustrated example thatthe primary-responsibility table 1040 can be viewed as having beendivided into 3 general groups of priority based on the ACTION (column1008) being requested. The SEND action requested in row 1017 belongs tothe highest general priority group because it is alerting/notifying theMSP of a new medical condition the MSP was probably not aware of yet,namely, that a positive strep throat culture has just been reported bythe lab for the Patient named Steve Winton. (Prior to this, thephysician could not have been certain that the Patient had this newmedical condition.) The REVIEW actions requested in rows 1018, 1020,1019 belong to a next lower, general priority group because they arealerting/notifying the MSP of situations that his/her office was atleast partially aware of, namely for example, that Patient Alice Holeshas asthma, even though the office may not have been aware of the latestchange in condition, namely that Patient Holes' peak flow is abnormallylow (see column 1014). The BLANK (unnamed) actions implied in rows 1021,1023, 1024 belong to a yet next lower, general priority group becausethey refer to situations the MSP has already reviewed, but for onereason or another, has decided to “keep” on his/her Alerts-SummarizingList (see button 1706 in FIG. 19). Therefore it may be seen from theexample of table 1040 in FIG. 10A that the Alerts/Notices sorting rulesfor that particular MSP are sorting primarily based on ACTION field1008, and then secondarily perhaps, on Alert-types of field 1016 (InfoAlert versus Retrieval Alert), and then thirdly perhaps, on Alert-Notesof field 1014 (e.g., PeakFlow Low takes precedence over No-AppointmentMade). The sort strategy used in the MA's list of delegated Actions, onthe other hand, may be based primary on the Alert-summarizing Notesfield 1014. Thus each Summaries-receiving recipient may see adifferently sorted presentation of Alert/Notification summaries based onthe role and/or other attributes of the recipient. Moreover, as will beseen shortly, each Summaries-receiving recipient may receive a differentset of summaries for presentation on-his/her, personalAlerts/Notifications Summary List. So the specific summaries that arepresented by the System to each Person may different on aperson-by-person basis. For example, one Medical Assistant may servicethe practices of several physicians in a given clinic. Each suchphysician may be limited by the System to receiving presentations ofAlert/Notification Summaries involving only the Patients of thatspecific physician. The MA, on the other hand, may receive the delegatedsummaries from all those physicians. It may be noted in passing thatalthough a particular approach to sorting presented-alert-summaries isshown in the example of FIG. 10A, other embodiments may use differentsorting schemes for presented-alert-summaries or no sorts at all.

The created Alert or Notification 1080 and/or its corresponding summary1080 a should include some identifier of, or pointer to (1081) theunderlying message (e.g., 1065) which provoked the Alert or Notificationcreation step 1070 a. Such an identifier/pointer 1081 allows the Systemto fetch detailed information about the underlying cause of theAlert/Notification creation 1070 a as may be appropriate. In additionto, or as an alternative to the provision of the identifier 1081 of theunderlying message (e.g., 1065), the created Alert or Notification 1080and/or its corresponding summary 1080 a may include an identification1091 of the Target (e.g., Patient) associated with theAlert/Notification creation 1070 a as may be appropriate. (In analternate or varied embodiment, a list of latest communications sent toeach Target may be kept in chronological or other appropriate order andmay be used by the System for fetching more detailed information aboutthe underlying cause(s) of the Alert/Notification creation 1070 a.

For purposes of providing a useful summary to the recipient (e.g., MSP)of the Alerts Summary presentation (e.g., FIG. 10A), the created,summary data structure 1080 a should include an Alert-summarizing Notesection 1094 that is filled upon creation to contain anAlert-summarizing Note as discussed above or a pointer to (identifierof) such a Note. The other item which the recipient (e.g., MSP) of theAlerts Summary presentation would probably want to be informed of by wayof summary is the Patient name (Target ID 1091, see also column 1011 ofFIG. 10A). Dashed line 1083 represents, for one class of embodiments, adividing line between what might be deemed essential in certainApplications for providing a useful Alerts Summary presentation (aboveline 1083) and what might be desirable but not as vital (below line1083).

Another part of the summary data structure 1080 a that may be relativelyvaluable, is a field 1088 indicating the Alert-Handling Action beingRequested. This corresponds to column 1008 of FIG. 10A, and as indicatedabove, the contents of the Alert-Handling Action Requested field 1088may be used in machine-implemented step 1072 for adjusting priority forpurposes of subsequent sorting 1073 and/or for other purposes. The base,and/or thereafter adjusted priority value(s) may be kept in field 1082of the summary data structure 1080 a.

Yet another part of the summary data structure 1080 a that may berelatively valuable for purpose of presenting a summary of anAlerted/Notified situation, is a field 1096 indicating theAlert-Causation Type. This corresponds to column 1016 of FIG. 10A (AlertType). As indicated above, the contents of the Alert-Causation Typefield 1096 may be used in machine-implemented step 1072 for adjustingpriority for purposes of subsequent sorting 1073 and/or for otherpurposes. The summary data structure 1080 a may have yet other fields(represented by box 1089) which may be useful for providing summarizedinformation about the underlying Alert 1080 and/or its correspondingmessage 1065. The summary data structure 1080 a may be contained in, orpoint to its corresponding, and usually more detailed, Alert datastructure 1080. The main Alert data structure 1080 may contain dataand/or logic for generating the zoom-in-on-details presentations such aswas exemplified above by FIGS. 12-24.

Each created summary data structure 1080 a (and in one less-efficientembodiment, also its corresponding main Alert data structure 1080)should be replicated (instantiated) a number of times according to thenumber of persons who are initially to have the summary included ontheir respective Alerts/Notifications Summary List. Each suchinstantiated Alerts/Notifications Summary data structure 1080 a (and inone less-efficient embodiment, also its correspondingly, replicated mainAlert data structure 1080) may then be optionally processed through acorresponding, recipient-centric, priority adjusting means (1072, 1072′,etc.) and/or a corresponding, recipient-centric, summaries sortingmechanism (1073, 1073′, etc.) so that the newly instantiatedAlerts/Notifications Summary data structure 1080 a may be appropriatelypresented (e.g., 1074) to the summary recipient on a recipient-centricbasis.

As has already been explained, each Summary-recipient (e.g., PrimaryCare Provider, Medical Assistant, etc.) may be empowered to zoom-in 1075on details of the main body Alert/Notification 1080 that underlies thesummarized Alert/Notification depending on System-assigned privileges.At least one System-authorized Person (e.g., the PCP) should beempowered to delegate (1076) the responsibility for responding to apending Alert to another Person (e.g., the Medical Assistant). Such adelegation is represented in FIG. 10B by the flow 1068 of acorresponding Alert/Notification Summary data structure 1080 a throughoptional function box 1067 and into routing structure 1071 for routingto the delegee (e.g., the MA). The delegation function should report itsactivities to an Audit Trail recording mechanism 1079 so that the Systemhas a traceable record of how the summarized Alert/Notification wasdisposed of. The optional, priority-override function box 1067represents the privileges-empowered option that may allow a PCP or othersuch trusted person to change the base priority value stored in section1082 before the summarized Alert/Notification is routed throughstructure 1071 to the delegee. The delegee's (e.g., MA's)priority-adjusting mechanism may then further process thisoverride-generated, priority value (1082) as may be appropriate.

Yet another option that at least one System-authorized Person (e.g., thePCP) may have, is to delete (1077) the summarized Alert/Notificationfrom his/her personal Alerts/Notifications Summary List. Thesummary-delete function should report its activities to the Audit Trailrecording mechanism 1079 so that the System has a traceable record ofhow the summarized Alert/Notification was disposed of Deletion of asummarized Alert/Notification from a corresponding Person'sAlerts/Notifications Summary List does not necessarily include fulldeletion of the corresponding, main body Alert/Notification 1080 fromthe System. As should now be apparent, the Audit Trail recordingmechanism 1079 may still point to the main body Alert/Notification 1080even though one Person has deleted the respective summary from his/her,personal Alerts/Notifications Summary List (if empowered by the Systemto so do). Also, the routed Alert/Notification Summary data structures(1080 a, only one shown) of other persons may still point (reference),the corresponding, main body Alert/Notification 1080.

If a so-empowered, recipient (e.g., the Primary Care Provider) of anAlert/Notification Summary decides to “handle” the underlyingAlert/Notification 1080 by, for example, formulating and/or sending anInterview that addresses concerns raised by the underlyingAlert/Notification 1080, then a control path such as illustrated at 1057may be taken. The Alert/Notification handling person (e.g., the PCP)formulates one or more follow up Interviews. The handling function(s)1078 should report its/their activities to the Audit Trail recordingmechanism 1079 so that the System has a traceable record of how thesummarized Alert/Notification and/or the underlying Alert/Notification1080 were responded to. Under one optional, handling approach (1059),when the Alert/Notification handling person (e.g., the PCP) instantiatesthe formulated response (e.g., by activating the SEND button), thecorresponding Alert/Notification Summary data structure 1080 a isautomatically removed from his/her, personal Alerts/NotificationsSummary List. The System is handed the responsibility of seeing to itthat the instantiated follow up Interview(s) are delivered in timelyfashion or that, otherwise a responsible person is alerted of the faileddelivery attempt (1063) or of spoilation (1061) of the follow upInterview(s).

Under a second optional, handling approach (1058), when theAlert/Notification handling person (e.g., the PCP) instantiates theformulated response (e.g., by activating the SEND button), thecorresponding Alert/Notification Summary data structure 1080 a isautomatically modified (e.g., by changing the contents of itsAlert-Handling Action Requested field 1088, for example to BLANK as inthe example of row 1024 of FIG. 10A and/or by changing its currentpriority value (1082) as may be appropriate, for example by reducingthat value 1082) and the so-modified Alert/Notification Summary datastructure 1080 a is kept on his/her, personal Alerts/NotificationsSummary List for optional later referral to. The System is still handedthe responsibility of seeing to it that the instantiated follow upInterview(s) are delivered in timely fashion or that, otherwise aresponsible person is alerted of the failed delivery attempt (1063) orof spoilation (1061) of the follow up Interview(s). Accordingly,responsibility is maintained by at least one of the System and aresponsible Person for seeing to it that each urgent Alert and/orNotification is taken care of, or that a recorded audit trail (1079, seealso item 1814 of FIG. 18) is generated to show why the Alert and/orNotification was not taken care of.

It is possible to have situations in which one or more Alerts and/orNotifications are not taken care of for an excessively long time (wherethat excess is defined by the respective Application) even though thecorresponding summary was presented in the Alerts/Notifications SummaryLists of one or more persons. (One possibility is that the situation washandled outside the auspices of the System and no one took the troubleto properly inform the machine-implemented System of that off-Systemdisposition. Accordingly, an automated garbage collecting mechanism 1099may be provided for periodically scanning through the System Databaseand erasing excessively old Alerts (spoiled Alerts). The garbagecollecting mechanism 1099 may also automatically erase sufficiently oldones (where the value for what constitutes sufficiently old is definedby the respective Application) of the main body Alert/Notifications 1080that are marked as having been “deleted” (in the 1077 sense, and/or inthe FIG. 18 sense) by actions of an appropriately responsible person(e.g., the PCP).

Given that machine-implemented and automated handling of the abovesituations is contemplated herein, it is to be further understood thatcomputer-readable mediums (e.g., 88 of FIG. 1A) or another form of asoftware product or machine-instructing means (including but not limitedto, a hard disk, a compact disk, a flash memory stick, a downloading ofmanufactured instructing signals over a network (e.g., 89 of FIG. 1A)and/or like software products) may be used for instructing aninstructable machine (e.g., 80 of FIG. 1A) to carry out suchmedical-communications facilitating activities (e.g., 95 of FIG. 1A)and/or medical-action facilitating activities (e.g., 65/26 of FIG. 1A)in accordance with the disclosure provided herein. As such, it is withinthe scope of the disclosure to have a one or more instructable machines(e.g., server and client computers, PDA's, 3G cell phones, etc.)automatically carry out one or more of the disclosed methods, and/or itis within the scope of the disclosure to provide one or more softwareproducts adapted for causing such instructable machines to carry out

Various features that may be included in Systems in accordance with thepresent disclosure are as follows:

1. A single alert screen (or other summarized-alerts reportingmechanism) may be provided that displays (or otherwise reports) one ormore of: test result delivery alerts, health maintenance alerts,specialist referral alerts, test referral alerts, custom message alerts,failure to keep appointment alerts, and test result alerts, in asummarizing manner that allows a Medical Service Provider to easilymonitor and thereby be kept aware of present time situations that areworthy of keeping a watch over, such as one or more critical clinicalsituations developing under his/her practice. Using such asummarized-alerts reporting mechanism the MSP can select a given one ofthe summarized alerts and receive further details regarding it and/orthe MSP can be further empowered to issue responses via the System forhandling the detailed alert-situation, such as initiating an Interviewwith the Patient or another Person (e.g., a consultant) or delegatingthe handling of the situation, with inclusion of MSP-providedinstructions, to a Back-up physician, a Medical Assistant or anothersuch Person.

2. A single screen (or other summarized-risks reporting mechanism) maybe provided that displays (or otherwise reports) about one or moreclinical situations which a Medical Service Provider has enhanced legal-and/or financial liability risks for under in his/her medical practiceso that the at-risk MSP can easily monitor and thereby be kept aware ofpresent time, risk-laden situations that are worthy of keeping a watchover, such as one or more high-exposure clinical situations developingunder his/her practice.

3. Means are provided for a Medical Assistant and/or another trusted andmedically-trained Person to access the same single alert screen (orother summarized-alerts reporting mechanism) with selectively assignableprivileges being given to that other trusted and medically-trainedPerson to interact with and respond to alerted situations.

4. Means are provided for facilitating the generation ofsituation-appropriate, timed and automated Patient follow-up Dialogs orInterviews for medical conditions indicated by the alert-detailingreports where content within the facilitated, Dialogs or Interviews isadaptively pre-defined in accordance with Patient Attributes known tothe System and/or in accordance with present medical conditionsindicated by relatively recent Dialogs or Interviews to be developing ina present time. Further means may be provided to adjust presentablecontent of current and/or future Dialogs in response to currentpatient's responses—in other words, adaptive prompting.

5. An automated means is provided to adjust a paradigm of usabledelivery strategies on a Target-by-Target basis in response to personalattributes of the communication Target (e.g., Patient Attributes), inresponse to Interview answers or lack of answers provided by thecommunication Target (e.g., the responses that a Patient provides withregard to an Interview concerning an illness, and/or in regard to thecourse of the Patient's illness and/or treatment progress). Also,Adaptive Message assigning means are provided for adaptively assigningdifferent content to Dialog flow trees based on one or more of thepersonal attributes of the communication Target (e.g., PatientAttributes) and the Interview answers or lack of answers provided by thecommunication Target.

6. The System can include Delivery strategies that are Rule-based andthat determine routing of Instantiated Dialogs among differentcommunication channels in accordance with corresponding Deliverystrategy Rules for the respective Dialogs. The Delivery strategy Rulescan provide automated routing decisions which are responsive topreferences of one or more of Service Providers, Patients, or MedicalFacilities; the nature of the message being sent; the content of themessage being sent; and Patient, Provider, and Medical FacilityAttributes.

7. The System can use the Interviews which it generates, delivers and/ormanages to gather information about respective communication Targets(e.g., Patients) over a time period. The System includes AlertGenerating means to automatically Alert a responsible Service Providerof automatically-detected problems concerning: delivery or non-deliveryof various, note-worthy Dialogs, and/or information obtained over saidtime period by the carrying out of Interviews or Dialogs, where theautomatic detection of problems can be based on Service-Organizationdefined standard rules and/or personal attribute values of thecommunication Target.

8. The System can include coordinated, multi-media means to use multiplemedia types to deliver messages wherein receipt of message in one mediatype cancels message delivery attempts in other media types. Thiscoordinated approach to using different communication channels canreduce annoying repetitions of message deliveries that communicationTargets may experience in non-unified, uncoordinated systems which relyon automated content delivery.

9. The System can include automatic delivery-failure notification meansto notify a Service Provider, in near real-time, of a failure ofSystem-attempted communications to adequately follow up on the stateand/or progress of medical conditions of specific Patients.

10. The System can include automatic content selection means for formingthe content of messages based on a Patient or other Target's personalhealth or other Attributes, where the content selection can be furtherresponsive to the means chosen for delivery or presentation of contentinformation.

11. Means for enabling a Medical Service Provider to easily (e.g.,one-click) add Addendum phrases to boiler-plate message templates thatare automatically pre-filled with Target-specific data.

12. Audit-trail creating means for assisting a Medical Service Provideror Medical Assistant to add selectable or customizableDeletion-justification phrases to [standard] message histories toindicate how an Alerted message was handled prior to, or around the timeof its deletion from an Alerted messages list.

13. Responsibility Delegation Means for allowing a Medical ServiceProvider to delegate through the System, responsibility for reacting toone or more alerted messages to Medical Assistants and to indicate,through the System, how the MSP desires the alerted situation to behandled by the delegated-to MA.

14. Means to pack and deliver several messages to a given Target in asingle contact with said messages ordered by Priority responsive totheir respective message content, Topic priority or Applicationpriority, Target Attributes, and/or prior delivery attempts and resultsof such attempts.

15. Means to pack and deliver several messages to a given Target in asingle contact where said messages may originate from different senders.

16. Automated instantiation of Health Maintenance Interviews and oftheir respective delivery schedules in response to Patient Attributesand/or Provider Attributes currently stored in the System Database.

17. Means for “Guest/Backup Service Providers” to use a Primary ServiceProvider's Account with limits of time and access to certaincapabilities and screens.

18. Means to deliver several messages to a given Target using a set ofdelivery channels and providing a selected number of messages to eachchannel proportional to that channel's ability (bandwidth andavailability) to deliver said messages in a timely manner so as not toimpede promptness of subsequent message deliveries via suchcommunication channels.

9. The Service Provider is given a clarification-supporting means fordelivering further information regarding the content of a boiler-plateDialog by way of automated delivery of a subsequent Custom Dialog thatis delivered with the boiler-plate Dialog.

20. Means responsive to Rules of advising a Patient that Alerted(note-worthy) Interview Dialogs are awaiting his or her access.

21. Means of assigning appropriate health maintenance monitoringinterviews responsive to Patient's Attributes and other Attributes.

22. Delivery strategies that are responsive to Successive ContentOrdering Rules (e.g., Progression Requirements) regarding Dialogs orInterviews that should be delivered in a particular, preferentialsequence.

23. InterDialog Time Gap and Interview Dialog Delivery Rules whichautomatically provide for proper minimum spacing between deliveries ofsuccessive Dialogs of a given follow up Interview.

24. Interview has a NeedsReview property that can be set True or Falseby rules responsive to Dialog content or Medical Facility or ProviderAttributes.

25. System can generate and store the definition of an Interview TargetGroup whose members may be selected based on one or more PersonAttributes and the System can then instantiate Interviews for eachmember of formed Group.

26. The System can be expanded to add new Applications (e.g., newService-Providing Organizations or subsets thereof) without having togenerate new Person records for each added Application. Roles of Personscan be changed under each Application as persons change roles withrespect to such Service-Providing Organizations (e.g., clinics,hospitals, etc.).

27. The System can sift off Patient-centric, “normal” test and/orInterview results for respective Patients who are doing well and therebyleave behind for human intervention only those situations where for thegiven Patient (Patient-centric sifting), the obtained test and/orInterview results are worthy of human intervention such as being lookedat and/or reacted to by a care-concerned service provider such as adoctor, nurse or other trained member of the Service-ProvidingOrganization that is providing health or medical care related servicesto the Patient.

Other: Essentially all tests can be reported in a practice due toSystem's efficiency-hence, operating policy can be if patient does nothear re test, then patient should contact office as something is amiss.

In view of the above, the present disclosure is to be taken asillustrative rather than as limiting the scope, nature, or spirit of thesubject matter claimed below. Numerous further modifications andvariations may become apparent to those skilled in the art afterstudying the disclosure, including use of equivalent functional and/orstructural substitutes for elements described herein, use of equivalentfunctional couplings for couplings described herein, and/or use ofequivalent functional steps for steps described herein. Suchinsubstantial variations are to be considered within the scope of whatis contemplated here. Moreover, if plural examples are given herein forspecific means, or steps, and extrapolation between and/or beyond suchgiven examples is obvious in view of the present disclosure, then thedisclosure is to be deemed as effectively disclosing and thus coveringat least such extrapolations.

Given the above disclosure of general concepts and specific embodiments,the scope of protection sought is to be defined by the claims appendedhereto.

1. A machine-implemented method for notifying at least onecare-concerned person such as a medical service provider or a medicalassistant to a health or medical care-related situation constituted byat least one of the following notification worthy situations: (0.1)completion of a care-related task where said task completion calls forrelatively prompt attention thereto; (0.2) in-completion of acare-related communication delivery-attempt where said in-completion ofthe delivery-attempt calls for relatively prompt attention thereto;(0.3) in-completion of a care-related task where said in-completion ofthe care-related task calls for relatively prompt attention thereto;(0.4) an unexpected change or a lack of expected change in a medicalcondition of a given patient where said unexpected change or lack ofexpected change calls for relatively prompt attention thereto; and (0.5)an apparent failure to notify a primary medical service provider, or aprimary medical assistant as may be appropriate, of one of the abovenotification-worthy situations; where said machine-implemented alertingmethod comprises: (a) monitoring communications related to progress orlack of progress in timely completion of pre-scheduled, care-relatedtasks and related to timely completion of pre-scheduled, care-relatedcommunication delivery-attempts and related to medical conditions ofrespective ones of plural patients; (b) identifying among the monitoredcommunications those which are indicative of at least one of saidcare-related situations that call for relatively prompt attentionthereto by a care-concerned person such as the medical service providerand the medical assistant, where criteria for determining whether or nota given situation is one that calls for relatively prompt attentionthereto are machine-defined and where timeliness of pre-scheduled onesof said care-related tasks and care-related communicationdelivery-attempts are machine-defined; and (c) for an identified one ofthe monitored communications which is indicative of at least one of saidcare-related situations that call for relatively prompt attentionthereto, initiating a delivery-attempt for delivering to at least onetargeted recipient in a group comprised of said medical service providerand medical assistant an alert signal for notifying the targetedrecipient of the monitored and identified communication.
 2. An alertingmechanism for summarily alerting a care-concerned person such as amedical service provider or a medical assistant to a care-relatedsituation constituted by at least one of the following situations: (0.1)completion of a care-related task where said task completion calls forrelatively prompt attention thereto; (0.2) in-completion of acare-related communication delivery-attempt where said in-completion ofthe delivery-attempt calls for relatively prompt attention thereto;(0.3) in-completion of a care-related task where said in-completion ofthe care-related task calls for relatively prompt attention thereto; and(0.4) an unexpected change or a lack of expected change in a medicalcondition of a given patient where said unexpected change or lack ofexpected change calls for relatively prompt attention thereto; wheresaid alerting mechanism comprises: (a) action requesting means faradvising the care-concerned person of an attention-giving action that isto be provided by the care-concerned person or delegated to anothercare-concerned person in response to an alerted situation; (b) topicdefining means for advising the care-concerned person of the medicalconcern that is addressed by the alerted situation; (c) patientidentifying means for advising the care-concerned person of the identityof one or more patients associated with a corresponding attention-givingaction and a corresponding medical concern that is addressed by thealerted situation; and (d) situation identifying means for advising thecare-concerned person of a situation type to which the alerted situationbelongs.
 3. The alerting mechanism of claim 2 wherein: (a.1) said actionrequesting means includes means for advising the care-concerned personto at least provide an attention-giving action selected from theattention-giving group consisting of: (a.1a) initiating a sending oftest results to a tested patient to at least thereby let the testedpatient know that the results have been received by the care-concernedperson; (a.1b) reviewing contents of an automated or semi-automatedinterview conducted with a corresponding patient; and (a.1c) becomingaware of a failed attempt to deliver a communication relating to acorresponding patient; (b.1) said topic defining means includes meansfor advising the care-concerned person of at least one of the medicalconcerns in a topic group consisting of: (b.1a) an identifier of a bloodcomponent that is of concern; (b.1b) an identifier of a chronic diseasethat is of concern; (b.1c) an identifier of an on-setting disease thatis of concern; (b.1d) an identifier of a body part or body system thatis of concern; and (b.1e) an identifier of a type of test or othermedical procedure that is of concern; and (d.1) said situationidentifying means includes means for advising the care-concerned personof at least one of the situation types in a situation type groupconsisting of: (d.1a) a retrieval failure situation in which acorresponding communication delivery attempt was not timely or fullycompleted; and (d.1b) an information-triggered situation in whichinformation gathered during a corresponding communication deliveryattempt triggered the alerted situation.
 4. The alerting mechanism ofclaim 2 and further comprising: (e) topic category defining means foradvising the care-concerned person of a system-supported categoryencompassing the medical concern that is addressed by the alertedsituation.
 5. The alerting mechanism of claim 2 and further comprising:(e) privilege controlling means for controlling alert-disposingprivileges of pre-specified ones of care-concerned persons to certainclasses or specific ones of attention-giving actions.
 6. A follow-upscheduling and monitoring mechanism for automatically assisting acare-concerned person such as a medical service provider or a medicalassistant in scheduling one or more health or medical care follow upactions following a first care-related situation constituted by at leastone of the following situations: (0.1) completion of a first examinationwhere an initial assessment of patient condition was made and one ormore follow up medical tests were ordered; (0.2) in-completion of acare-related communication delivery-attempt where said in-completion ofthe delivery-attempt calls for relatively prompt attention thereto;(0.3) in-completion of a care-related task where said in-completion ofthe care-related task calls for relatively prompt attention thereto; and(0.4) an unexpected change or a lack of expected change in a medicalcondition of a given patient where said unexpected change or lack ofexpected change calls for relatively prompt attention thereto; wheresaid follow-up scheduling and monitoring mechanism comprises: (a)adaptive scheduling means for adaptively scheduling one or moreattention-giving, follow up actions that are to be providedchronologically in response to the first care-related situation; and (b)patient attribute defining means for defining one or more health-relatedattributes of the under-care patient which can affect the carrying outof said, one or more attention-giving, follow up actions that are to beprovided.
 7. In a machine-implemented, communications managing anddelivering system having at least one of: (0.1) filtering means forautomatically identifying intervention-worthy communications which areworthy of being reviewed by a human intervener; and (0.2) taskin-completion detecting means for automatically detecting note-worthyfailures to complete attempted communications and/or note-worthyfailures to complete scheduled action items; where the communicationsmanaging and delivering system further includes an alert generatingmeans for generating alert reports indicative of at least one categoryof said intervention-worthy communications, note-worthy failures tocomplete attempted communications, and note-worthy failures to completescheduled action items; an alerts summarizing mechanism comprising: (a)prioritizing means for prioritizing alert reports according to theircomparative intervention-worthinesses. or note-worthinesses, where saidcomparative worthiness characteristics are machine-defined; and (b)target-person identifying means for identifying a target-person to whomone of said intervention-worthy communications is to be sent, or onwhose behalf a note-worthy failure to complete an attemptedcommunication occurred, or on whose behalf a note-worthy failure tocomplete a scheduled action item occurred.
 8. The alerts summarizingmechanism of claim 7 and further comprising: (c) summarized alertsreporting means for reporting summarizations of the prioritized alertreports to at least one person responsible for reacting to the alertreports; and (d) details providing means for providing more detailsabout an alert report summarized by one of the reported summarizationsin response to the at least one responsible person selecting one of thereported summarizations.
 9. The alerts summarizing mechanism of claim 8and further comprising: (e) delegation means for allowing said at leastone responsible person to delegate to at least a second responsibleperson with instructed actions and by way of said communicationsmanaging and delivering system, the responsibility of reacting to aselected one or more of the alert reports.
 10. The alerts summarizingmechanism of claim 8 and further comprising: (f) delegation trackingmeans for allowing said at least one responsible person to track thecarrying out of respective ones of said instructed actions by the atleast second responsible person to whom was delegated the responsibilityof reacting to respective ones of said alert reports.
 11. Amachine-implemented, communications formulating, managing and deliveringsystem comprising: (a) interview formulation assisting means forassisting a user in formulating an interview that is to be delivered toone or more targeted persons; (b) interview delivery scheduling meansfor scheduling time ranges in which attempts will be made to deliver oneor more formulated interviews; and (c) interview completion checkingmeans for checking that a scheduled interview was timely conducted, orif not, for alerting a responsible person of the in-completion of thescheduled interview.
 12. An adaptive dialog conducting mechanism for usein a communications managing and delivering system where thecommunications managing and delivering system stores attributesdescribing potential target persons to whom communications may be sent;and where said adaptive dialog conducting mechanism comprises: (a) adecision tree having one or more dialog flow paths that are to befollowed during automated carrying out of the adaptive dialog, where theone or more dialog flow paths that are followed can be selected in realtime response answers or lack of answers provided by the communicationtarget person; and (b) a presentable data section for storingcontent-variable data that is to be presented at respective nodes of thedecision tree, where the content-variable data may be generated inresponse to personal attributes of the communication target person. 13.The adaptive dialog conducting mechanism of claim 12 and furthercomprising: (c) a collectable data section for storing response and/ornon-response data generated during the automated carrying out of theadaptive dialog.
 14. A machine-implemented, communications deliveringand response collecting system comprising: (a) interview conductingmeans for delivering an interview through a communications channel to atarget person and for collecting data representative of responses ornon-responses by the target person to the delivered interview; and (b)alert generating means for analyzing said responses or non-responses bythe target person to the delivered interview and for selectivelygenerating an alert signal in accordance with alert rules providedwithin the system.
 15. A machine-implemented, communications deliveringsystem comprising: (a) a plurality of channel managers each for managingdelivery of one or more interviews through a manager-specificcommunications channel; and (b) a delivery scheduler operatively coupledto the plural channel managers for delegating delivery-attemptresponsibilities for specific messages to respective subsets of theplural channel managers and for undoing respective ones of saiddelegations when one of the channel managers succeeds in delivering arespective one of the specific messages.
 16. A scalablemachine-implemented, communications delivering and response collectingsystem comprising: (a) an application server for processing respectivedata communications under pre-assigned service-organization designations(applications); and (b) a database for storing: (b. 1) respective,communication processing rules of respective ones of said pre-assignedservice-organization designations; and (b.2) persons records definingperson attributes of respective persons who can have service-providingand/or service receiving roles under each of said service-organizationdesignations.
 17. For use in a service providing organization, amachine-implemented method for increasing likelihood thatservice-related communications will be delivered to and retrieved bycommunications-targeted persons, said machine-implemented methodcomprising: (a) adaptively defining multi-channel delivery strategiesover time for potential, communications-targeted persons based onprevious delivery-attempt histories so as to increasing likelihood ofdelivery success to specific ones of said potential,communications-targeted persons when a next communication is targeted toone or more of such potential, communications targeted persons; (b)requesting confirmation by communications-targeted persons of receiptand understanding of delivered ones of said communications; and (c) iffailed delivery-attempts exceed predefined thresholds orcommunications-targeted persons fail to confirm receipt andunderstanding of delivered ones of said communications within predefinedtime limits, routing alerts to responsible persons within the serviceproviding organization asking them to respond to the failedcommunications attempts.